Barriers to addiction-related care during pregnancy in Nigeria: a scoping review and health system policy analysis

Ovie M. Albert, Alexander Arthur, Ivor O. Orukpe

Abstract

Substance-related exposures in pregnancy are documented across Nigeria, but their integration into antenatal care remains unclear. This scoping review and health-system policy analysis mapped empirical evidence on these exposures among pregnant women and examined barriers to perinatal addiction-related care. Addiction-related care is understood here as screening, risk assessment, counselling, documentation, referral, and treatment. Five databases were searched on 6 April 2026; 23 empirical studies were synthesised with national policy documents and clinical guidelines using the WHO health-systems building blocks framework. Alcohol, herbal preparations, kolanut, self-medication with pharmaceuticals, and psychoactive substances including opioids were reported across all six geopolitical zones. No included study described routine screening, standardised documentation, structured referral, or integrated perinatal addiction-care pathways. Barriers included fragmented service delivery, workforce gaps, weak information systems, restricted pharmacotherapy access, financing constraints, stigma, and criminalisation. Non-punitive screening and referral pathways should be integrated into antenatal care to improve maternal and newborn outcomes.

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References

Adeoye IA. Alcohol consumption and tobacco exposure among pregnant women in Ibadan, Nigeria. BMC Psychiatry 2022;22(1):570. doi:10.1186/s12888-022-04210-9.

Adeoye IA and Etuk V. Prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicine use in Ibadan, Nigeria. BMC Complement Med Ther 2023;23(1):17. doi:10.1186/s12906-023-03838-8.

Adanikin AI and Awoleke JO. Antenatal drug consumption: the burden of self-medication in a developing world setting. Trop Doct 2017;47(3):193-7. doi:10.1177/0049475516653067.

Atiba AS, Adetoyese MO, Olawoyin DS, Akinlua I, Atiba EO, Akinleye CA and Ogunbode OO. Caffeine consumption among pregnant women attending antenatal clinic at the University College Hospital, Ibadan, Nigeria. Sci Rep 2023;13(1):14422. doi:10.1038/s41598-023-41598-0.

Adebowale OO and James BO. Psychoactive substance use and psychiatric morbidity among pregnant women attending an ante-natal clinic in Benin City, Nigeria. Niger Postgrad Med J 2018;25(1):8-12. doi:10.4103/npmj.npmj_189_17.

Sulyman D, Ayanda KA, Dattijo LM and Aminu BM. Substance use among pregnant women attending an antenatal clinic in a tertiary health institution in north-eastern Nigeria. Sahel Med J 2021;24(1):28-33. doi:10.4103/smj.smj_42_19.

Popova S, Lange S, Probst C, Gmel G and Rehm J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob Health 2017;5(3):e290-9. doi:10.1016/S2214-109X(17)30021-9.

Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM and Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009. JAMA 2012;307(18):1934-40. doi:10.1001/jama.2012.3951.

Behnke M, Smith VC; Committee on Substance Abuse; Committee on Fetus and Newborn. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics 2013;131(3):e1009-24. doi:10.1542/peds.2012-3931.

World Health Organization. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Geneva: World Health Organization, 2014. ISBN: 9789241548731.

Committee on Obstetric Practice; American Society of Addiction Medicine. ACOG Committee Opinion No. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol 2017;130(2):e81-94. doi:10.1097/AOG.0000000000002235.

Wong S, Ordean A, Kahan M; Society of Obstetricians and Gynaecologists of Canada. SOGC Clinical Practice Guideline No. 349: substance use in pregnancy. J Obstet Gynaecol Can 2017;39(10):922-37.e2. doi:10.1016/j.jogc.2017.04.028.

National Institute for Health and Care Excellence. Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors. NICE Clinical Guideline CG110. London: NICE, 2010.

Substance Abuse and Mental Health Services Administration. Clinical guidance for treating pregnant and parenting women with opioid use disorder and their infants. HHS Publication No. (SMA) 18-5054. Rockville (MD): SAMHSA, 2018.

Federal Ministry of Health, Nigeria. National Health Policy 2016: promoting the health of Nigerians to accelerate socio-economic development. Abuja: Federal Ministry of Health, 2016.

Federal Ministry of Health, Nigeria. Second National Strategic Health Development Plan 2018–2022. Abuja: Federal Ministry of Health, 2018.

Federal Ministry of Health; National Drug Law Enforcement Agency; United Nations Office on Drugs and Crime. National Drug Control Master Plan 2021–2025. Abuja: Federal Ministry of Health, 2021.

Federal Ministry of Health, Nigeria; World Health Organization; United Nations Children’s Fund. Nigeria Every Newborn Action Plan: a plan to end preventable newborn deaths in Nigeria. Abuja: Federal Ministry of Health, 2016.

Federal Government of Nigeria. National Mental Health Act, 2021. Abuja: Federal Government Printer, 2023.

United Nations Office on Drugs and Crime; National Bureau of Statistics; Centre for Research and Information on Substance Abuse. Drug use in Nigeria: national survey 2018. Vienna: UNODC, 2019.

Federal Republic of Nigeria. National Health Act, 2014 (Act No. 8 of 2014). Abuja: Federal Government Printer, 2014.

Alare K and Muili A. The opioid crisis in Nigeria: a call for public health and policy interventions. Lancet 2024;404(10462):1518. doi:10.1016/S0140-6736(24)01855-5.

Albert OM and Beshara F. Addiction medicine in Nigeria’s Niger Delta: a scoping review of substance use epidemiology and interventions. Nig Del Med J 2025;9(4):1-15.

World Health Organization. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: World Health Organization, 2007.

Arksey H and O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8(1):19-32. doi:10.1080/1364557032000119616.

Levac D, Colquhoun H and O’Brien KK. Scoping studies: advancing the methodology. Implement Sci 2010;5:69. doi:10.1186/1748-5908-5-69.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö and Straus SE. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169(7):467-73. doi:10.7326/M18-0850.

Tamuno I, Omole-Ohonsi A and Fadare J. Use of herbal medicine among pregnant women attending a tertiary hospital in northern Nigeria. Internet J Gynecol Obstet 2010;15(2). doi:10.5580/2932.

American College of Obstetricians and Gynecologists Committee on Ethics. ACOG Committee Opinion No. 633: alcohol abuse and other substance use disorders: ethical issues in obstetric and gynecologic practice. Obstet Gynecol 2015;125(6):1529-37. doi:10.1097/01.AOG.0000466371.86393.9b.

El-Nahas E and Thibaut F. Perinatal substance use disorders: an overview. J Clin Med 2023;12(20):6473. doi:10.3390/jcm12206473.

Habersham LL, Townsel C, Terplan M and Hurd YL. Substance use and use disorders during pregnancy and the postpartum period. Am J Obstet Gynecol 2025;232(4):337-53.e1. doi:10.1016/j.ajog.2025.01.007.

Andualem F, Melkam M, Nakie G, Tinsae T, Fentahun S, Rtbey G, Takelle GM, Kibralew G, Mengistie BA, Gedef GM, Yirsaw AN and Tadesse G. The prevalence and associated factors of alcohol consumption among pregnant women in Africa: a systematic review and meta-analysis. BMC Psychiatry 2025;25(1):824. doi:10.1186/s12888-025-07260-x.

Okonkwo PI and Uwakwe R. Alcohol use, cigarette smoking, and other psychoactive substance use in pregnancy in a teaching hospital in eastern Nigeria. Niger J Med 2003;12(4):202-6.

Ordinioha B and Brisibe S. Alcohol consumption among pregnant women attending the ante-natal clinic of a tertiary hospital in South South Nigeria. Niger J Clin Pract 2015;18(1):13-7. doi:10.4103/1119-3077.146966.

Onwuka CI, Ugwu EO, Onwuka CI, Dim CC, Eleje GU and Iloghalu EI. Prevalence and predictors of alcohol consumption during pregnancy in South-Eastern Nigeria. J Clin Diagn Res 2016;10(9):QC10-QC13. doi:10.7860/JCDR/2016/19023.8449.

Usifoh SF, Aigbe E and Aigbe NI. Awareness, prevalence and pattern of alcohol use among pregnant women in Benin City, Nigeria. J Pharm Allied Sci 2018;15(3):2856-67.

Mbadugha CC, Ezeruigbo CFS, Anetekhai CJ, Onyiapat JE and Anarado AN. Prenatal alcohol intake and knowledge of effects of prenatal alcohol exposure

among pregnant women attending antenatal clinics in Enugu, Nigeria. Niger J Med 2022;31(2):174-81. doi:10.4103/NJM.NJM_151_21.

Achema G, Emmanuel A and Moda GB. An evaluation of the use of herbal drugs by pregnant women in Nigeria. Afr J Midwifery Womens Health 2012;6(2):78-83. doi:10.12968/ajmw.2012.6.2.78.

Duru CB, Uwakwe KA, Chinomnso NC, Mbachi II, Diwe KC, Agunwa CC, Iwu AC and Merenu IA. Sociodemographic determinants of herbal medicine use in pregnancy among Nigerian women attending clinics in a tertiary hospital in Imo State, South-East, Nigeria. Am J Med Stud 2016;4(1):1-10.

Dim CC, Ndubuisi UD, Ezugwu EC, Iyoke CA, Ugwu EO and Ezegwui HU. Knowledge, attitude and use of herbal medicine among pregnant women attending antenatal care in Nsukka, Nigeria. Afr Health Sci 2024;24(4):182-91. doi:10.4314/ahs.v24i4.24.

Jackson IL, Ottoho EM, Adeniran A and Ogunwale OA. Herbal medicine use during pregnancy and associated factors among women attending three secondary hospitals in Uyo, Akwa Ibom State, Nigeria. J Herb Med 2024;45:100881. doi:10.1016/j.hermed.2024.100881.

Amanesi OE, Imuetinyan EJI and Ekiti EO. Pattern of use and safety perception of herbal and complementary medicines among pregnant women attending antenatal clinics in Benin City, Nigeria. World J Biol Pharm Health Sci 2025;23(1):537-49.

Abasiubong F, Bassey EA, Udobang JA, Akinbami OS, Udoh SB and Idung AU. Self-medication: potential risks and hazards among pregnant women in Uyo, Nigeria. Pan Afr Med J 2012;13:15.

Akadri AA, Odelola OI, Salami AT and Adebanjo IA. Self-prescription of orthodox and herbal medicines among pregnant women attending antenatal care in Remo Zone, Ogun State, Nigeria. Ann Health Res 2025;11(2):141-53.

Ajogbon DO, Atulomah NOS and Adeola OG. Determinants of psychoactive substance use among pregnant women receiving antenatal care in selected

secondary health institutions in Ogun State, Nigeria. Int Neuropsychiatr Dis J 2018;11(1):1-12.

Anusiem CA and Nwafor SV. Pattern of psychoactive substance use among pregnant women attending antenatal clinics in Enugu, Nigeria. IOSR J Pharm Biol Sci 2020;15(3):8-12.

Mutihir JT, Musa J, Daru PH, Nyango DD and Audu MD. Substance abuse among antenatal patients at Jos University Teaching Hospital, North Central Nigeria. J West Afr Coll Surg 2012;2(2):50-62.

Otegbayo OA, Oduwole O, Ogunbode O and Olufunmilola A. Substance use disorder and academic performance among pregnant adolescents in selected Nigerian states. Int J Adv Appl Sci 2023;10(9):207-17. doi:10.21833/ijaas.2023.09.024.

Greaves L, Poole N and Brabete AC. Sex, gender, and alcohol use: implications for women and low-risk drinking guidelines. Int J Environ Res Public Health 2022;19(8):4523. doi:10.3390/ijerph19084523.

Albert OM. Opioid addiction medicine in Nigeria: bridging clinical gaps in a silent epidemic—a narrative review. Niger Med J 2025;66(6):2073-90. doi:10.71480/nmj.v66i6.824.

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