Obstetric fistula, a debilitating childbirth injury that causes continuous leakage of urine or faeces, leaves deep physical and emotional scars. But for thousands of Nigerian women, the journey from pain to healing is one of courage, resilience, and hope.
Once abandoned and stigmatized, many women now find rebirth through free surgical repairs and empowerment programmes. Their stories reflect not only loss but recovery—of dignity, identity, and strength.
The condition, caused by prolonged and obstructed labour without prompt medical care, results in an abnormal opening between the birth canal and bladder or rectum, leaving women incontinent.
Today, a growing movement—driven by survivors, medical professionals, and government support—is helping these women heal, rebuild, and inspire others. They are no longer silent victims but powerful voices reclaiming their place in society.
May 23rd, observed globally as the International Day to End Obstetric Fistula, brings renewed attention to a condition that disproportionately affects impoverished women in Nigeria’s rural communities.
In Nigeria, where healthcare access is uneven, UNICEF estimates that 400,000 to 800,000 women are living with untreated fistula, with 13,000 new cases annually.
Mrs Safiya Babayo, a 23-year-old from Bauchi State, recounted her experience.
“I did not know what was happening to me; after delivery, I could not control my urine.
“The smell made people avoid me; my husband abandoned me; I hid myself for years,” she said.
Her isolation, like that of thousands of others, reveals a brutal intersection of poverty, gender inequality, and broken health systems.
Seventeen-year-old Mrs Aisha Lawal remembered the overwhelming joy of waking up to dry bedding after her successful obstetric fistula repair surgery.
Married and living in rural Gombe State, Lawal endured nearly a year of stigma, whispers, and self-imposed isolation due to the constant leaking of urine and the sharp odour that followed her everywhere.
She said that her life took a dramatic turn in 2024 when a community health worker and Fistula Champion from a local women’s network visited her home.
Lawal said that the worker linked her to free treatment at the National Obstetric Fistula Centre in Ningi, Bauchi State, through a special fistula repair initiative supported by the National Health Insurance Authority (NHIA).
She said that she developed an obstetric fistula after a three-day prolonged labour at a poorly equipped primary health centre in Yamaltu Deba Local Government Area.
“They gave me a cut to help the baby come out, referring to an episiotomy; tragically, the baby did not survive, and I was left with a condition that changed her overnight.
“I used torn pieces of wrapper as makeshift pads and changed them more than eight times a day.
“But the smell was still there; at the mosque, people would move away from me.
“During ceremonies, I noticed how people avoided sitting near me; I eventually stopped attending any gatherings; my mother and younger sister were my only support.’’
In early 2024, thanks to the NHIA’s support, she underwent a successful fistula repair surgery–the 14 days she spent at the centre were life-changing.
Alongside other women, she received health education, psychosocial support, and vocational training, including tailoring, soap-making, beadwork, and embroidery.
She said some religious organisations selected some of them to receive a start-up empowerment pack, which included a sewing machine, two rolls of fabric, thread, a tape measure, and sewing machine oil.
“I used to feel like my life was over; but now, people call me ‘Hajiya Mai Dinki’ (the woman who sews); I have found a new purpose and my dignity,” she narrated.
In June 2024, the Federal Government, through the Ministry of Health and Social Welfare, under the leadership of Prof. Muhammad Ali Pate, the Coordinating Minister, unveiled an ambitious Fistula Free Programme to eradicate the condition by 2030.
Jointly implemented with NHIA, the programme ensures women receive free fistula repair, transportation, feeding, and post-operative counselling.
As of January, key outcomes of the programme include 2,160 surgeries performed across 18 centres of excellence in nine states.
Additionally, 1,137 women have been enrolled in the NHIA scheme to ensure continuous access to maternal and reproductive healthcare.
The programme has also provided family planning services to 1,901 women to help prevent the recurrence of fistula.
Impressively, the surgical repair of vesico-vaginal and recto-vaginal fistulas has achieved a success rate of over 80 per cent.
Ms Deborah Adamu, a Nurse in Gombe, said that before NHIA came in, women had to buy their drugs or wait for donations
Adamu said that currently, they were treated with dignity, without paying a kobo.
For Mrs Mario Dikko, 35, from Katsina, the healing journey was long and winding.
“In December 2023, I went to Tanzania for surgery; it failed; I lost hope.
“But in 2024, I was referred to Katsina’s fistula centre through the Fistula Free Programme; today, I am healed; I walk with pride,” Dikko said.
Similarly, Mrs Safiyanu Moses once ostracised for the smell of incontinence, now helped others seek treatment.
“I was ignored; but today, I am like everyone else; I help women like me find hope,” Moses said.
Repaired physically, many women still battle emotional wounds from years of exclusion; that is where post-surgery reintegration becomes critical.
In Gombe State, more than 50 rehabilitated women were enrolled in vocational training and given startup kits for sewing, soap-making, and petty trade.
Mrs Zainab Bala, a 22-year-old survivor, said that when she left the hospital, she did not just return home, she returned as a tailor.
“I now train others; I am not a burden anymore,” Bala said.
This holistic model, surgery, mental health support, and economic reintegration, are being replicated in Bauchi, Kebbi, Katsina, and other states.
The programme’s success leans heavily on a strategic alliance between UNFPA, the Federal Ministry of Health, the Government of Norway, NHIA, and committed local institutions.
UNFPA, in particular, supports more than 3,000 free fistula repairs annually, deploys surgical teams, provides essential surgical kits, conducts behaviour change campaigns to reduce stigma, and supplies training manuals for health workers.
In 2020, UNFPA and the Health Ministry launched a National Social and Behaviour Change Strategy for the Elimination of Obstetric Fistula (2020–2024), a blueprint for fighting stigma and increasing community awareness.
With almost 40 per cent of global fistula cases found in Nigeria, these partnerships are not just helpful, they are essential.
Gesse VVF Centre in Birnin-Kebbi, one of 12 fistula repair hospitals nationwide, continues to provide care, yet capacity remains overstretched.
Despite the impressive strides, Nigeria still bears the third-highest burden of obstetric fistula in the world. Gaps in early marriage prevention, emergency obstetric care, rural health infrastructure, and public education persist.
Dr Solomon Okocha, a urogynaecologist in the FCT, offered insights.
“Fistula is not just a health issue; it is a reflection of systemic failures from education to access to emergency surgery.
“Until we fix those, the condition will remain.”
Okocha said that key challenges included cultural silence and stigma, limited awareness in remote areas, a shortage of trained fistula surgeons, poor referral systems, and a lack of data on untreated women.
“Countries like Malawi, Ethiopia, and Uganda face similar burdens; he urged cross-country learning.
“We must learn from each other; prevention, early detection, and reintegration must be community-led and country-owned,” he said.
Experts posit that ending fistula in Nigeria requires more than surgery; it will take political will, donor investment, stronger health systems, and societal compassion.
But above all, they say it requires active listening to the women behind the statistics.
