Northern Nigeria concentrates the highest number of fistula cases in the world: between 400,000-800,000 cases. A project started by UNFPA in 2009 with support from Virgin Unite, the non-profit foundation of the Virgin Group, is increasing access to free, quality fistula treatment in the region. The aim is to reduce the prevalence of this dreadful childbirth condition.
On average, Nigerian women have six children. The majority of the women deliver without the supervision of skilled birth attendants. Emergency obstetric care (EmOC) is scarce, making it more difficult to prevent maternal deaths and disabilities, like fistula, when a woman develops complications during delivery .
Caesarean sections, which are essential to save the mother and the baby's lives, as well as to help prevent fistula when obstructed labour occurs, are also a scarce resource in Nigeria. According the World Health Organization, at least 5 per cent of women should have access to C-sections in case of childbirth complications. Yet, in Nigeria it only occurs in 1 per cent of the cases. This situation results in one of the highest rates of maternal deaths in the world: 545 deaths per 100,000 live births.
For each woman who dies in childbirth, 20 other suffer different short- or long-term maternal disabilities, of which obstetric fistula is one of the most devastating. Globally it is estimated that 2 million women live with fistula, usually isolated due to the stigma associated with the condition.
Research suggests that there is a wide regional variation in the prevalence of fistula within Nigeria, with the northern part of the country and segments of the southeast zone having the highest rates. The differential rates are likely due to poverty, non-availability or lack of access to maternal health services, as well as cultural resistance to C-sections in some areas.
Selected health care facilities in the region are being strengthened through the project in partnership with Virgin Unite to provide emergency obstetric care, including C-sections, which will become an integral part of the services available to prevent maternal deaths, fistula and other disabilities.
"I am healed and very happy. My husband now wants me back." Zulai Shuaibu.
Facilities where fistula treatment services are available in Northern Nigeria are also being upgraded and expanded through the project. To ensure that women use the improved services, interventions such as community education will be introduced to motivate them toward prevention measures and, in case they already have the condition, seek treatment.
The project is also tackling the social exclusion and marginalization experienced by women who live with fistula through training and rehabilitation services that will facilitate the reintegration of fistula patients into their communities.
After the training: "Women in the community are coming to learn designs from me." Harira Auwalu.
Kori Habib reported from Nigeria.