Less than 24 hours after her cesarean section on April 30th at a government-run teaching hospital in Oron, a coastal community of Akwa Ibom in Nigeria, 24-year-old Gift Bassey-Eyo discovered she had developed a vesicovaginal fistula (VVF), a serious childbirth injury which creates a hole between the birth canal and bladder.
VVF is caused by prolonged, obstructed labor without access to timely, high-quality medical treatment. It predominantly affects women in rural or remote communities in developing countries. Bassey-Eyo endured obstructed labor for over nine days, ultimately leading to a stillbirth delivered via cesarean section. Attempts to push led to complications that triggered the VVF.
“It was the most challenging experience I’ve ever faced,” Bassey-Eyo says. “The situations were life-threatening. But I am glad that I emerged stronger.”
Bassey-Eyo and her family were referred to Family Life Centre, a VVF repair hospital run by Catholic Sisters of the Medical Missionaries of Mary (MMM) in Mbribit Itam, Uyo, located in the capital city of Akwa Ibom. The sisters-run center offers no-cost fistula surgeries and maternal and child health services to underserved communities, particularly those in remote areas with limited access to medical professionals. They provide both physical and spiritual support for women and girls in Akwa Ibom and neighboring states in Nigeria.
A Catholic model of collaborative care
The Medical Missionaries of Mary are one example of how Catholic groups play a vital role in providing formalized and affordable health care services across Nigeria and Africa. Through the efforts of priests, sisters, and various Catholic-related NGOs, the church offers important interventions in family planning, immunization, nutrition, water, sanitation, and hygiene (WASH), as well as overall health systems strengthening.
During the 2024 celebration of the World Day of the Sick on February 11, Pope Francis emphasized the fundamental significance and healing power of our relationships with one another and with God. “Our lives, reflecting in the image of the Trinity, are meant to attain fulfilment through a network of relationships, friendships and love, both given and received,” said the Pope. “We were created to be together, not alone.”
Medical Missionaries of Mary Sister Maria Obotama, whose order oversees the Family Life Centre, highlights that the increasing cases of VVF and RVF and other risks to women’s health in Nigeria are largely due to women’s lack of access to skilled medical professionals.
“Many women avoid hospitals and instead turn to traditional birth attendants, who often mishandle labor situations. We see a lot of these cases come through our doors, and they arrive with serious complications such as childbirth injuries, vaginal stenosis, urinary tract infections, and swelling or irritation in the area between the vagina and anus,” she explains.
Risk factors and gender inequality
Poverty, illiteracy, teenage pregnancy, and harmful practices such as female circumcision significantly increase the risk of obstetric fistula for women.
“We’ve also encountered a few incidents happening in churches, where some women claim they sought prayers before going into labor. They were often assisted by the pastor’s wife or other church members who attempted to handle the delivery themselves.”
Child marriage is another significant factor in challenges for women’s health in Nigeria. The nation is home to over 24 million child brides; nearly four out of 10 girls married before age 18. The ongoing failure to enforce international rights for the girl child across many Nigerian states allows early child marriage to persist. Currently, only 34 out of Nigeria’s 36 states have officially ratified the Child Rights Act, which is designed to safeguard children’s rights.
In the Catholic Church, current canon law sets the minimum age for marriage at 14 for females and 16 for males.
However, these ages are significantly lower than the recommendations set by the United Nations Populations Fund and the UNICEF, which suggest that the minimum marriage age for both men and women be established at 18 years. Even in Nigeria, this discrepancy is concerning; the 1999 Nigerian constitution regards marriage before this age as a violation of fundamental rights.
In February 2019, during a summit on sexual abuse held at the Vatican with a coalition of clergy, laity, and religious leaders, Pope Francis emphasized the need for concrete actions to combat child marriage. He proposed raising the minimum marriage age to 16 years old, highlighting the urgency of this issue.
“In the face of this scourge of sexual abuse perpetrated by men of the church to the detriment of minors, I thought I would summon you so that all together we may lend an ear and listen to the Holy Spirit … and to the cry of the small ones who are asking for justice,” the pope said.
Medical Missionaries of Mary Sister Sylvia Ndubuaku, area leader for West Africa with the order, highlights that early marriage is not only a sin before God but also a grave form of child abuse. “A 14-year-old girl is not yet a woman and, therefore, lacks the maturity to make informed decisions for herself. This issue requires immediate attention from both the church and global leaders.”
A fragile health care system
Nigeria also grapples with high maternal and infant mortality rates, with nearly 1,000 maternal deaths occurring for every 100,000 deliveries annually. A 2008 Nigeria Demographic and Health Survey showed that only 39 percent of childbirths were assisted by skilled birth attendants. Meanwhile, 22 percent were assisted by TBAs, and alarmingly, one in five births occurred without any assistance at all.
A staggering 90 percent of the population remains outside Nigeria’s health care insurance program, based on the 2018 Nigerian Demographic Health Survey. The country’s health care system is notably underfunded, contributing to rising maternal mortality rates and issues like obstetric fistula. This year, a mere 4.6 percent of the total budget has been dedicated to health.
The situation is exacerbated by a fragile health care infrastructure and mass emigration of skilled medical workers. While primary health care (PHC) forms a crucial component of a country’s health system, many rural communities in Nigeria lack access to PHCs. The few operational ones are at risk of disappearing, as many are either nonfunctional or in poor condition due to neglect and a shortage of staff.
Sister Maria explains that this has created a huge gap in health care interventions, adding that many women are referred to their facility for repairs of VVF and RVF. “Some discover us during our outreach programs and awareness campaigns; many have lived with these conditions for years, yet they often struggle to communicate their issues. They try to cope on their own, and as time goes on, they sustain more injuries.”
The group provides routine surgeries that take place every quarter of the year and announces these opportunities on the radio for anyone interested in visiting the center for treatment. Between 2019 and this year, they have successfully operated on 506 women, with 416 patients primarily from Akwa Ibom and the remaining 90 from neighboring states in the country.
A holistic approach to women’s health in Nigeria
The initiative is backed by a diverse group of supporters, including the Fistula Foundation, the Gay and Keith Talbot Foundation, the United Nations Population Fund (UNFPA), Misean Cara, ExxonMobil, Mboho Mkparawa Ibibio, and Nto Annang—an association of the Indigenous community in the United States. Financial support also comes from various individuals and organizations.
Collaboration also plays a key role in the efforts, with partnerships established with the University of Uyo Teaching Hospital, St. Luke’s Hospital Anua, Traditional Birth Attendants (TBAs), village leaders, church organizations, and mass media outlets such as radio stations and TV stations. Local social groups, like the Rotary Club of Akwa Ibom chapter, along with individuals known for their goodwill, also lend their support. NGOs, including the Help the Women campaign, further contribute to this vital initiative.
The facility also features a skill acquisition center, where beneficiaries are trained in acquiring various skills, such as soap making, baking buns, preparing fried snacks like Chin Chin, packaging peanuts, creating liquid antiseptic, hair styling, and clothing production. The facility includes a dormitory where patients stay while completing their skill acquisition programs. The sisters supply them with raw food ingredients, which they then cook themselves.
Obotama explains that the primary aim for the vocational training center is to empower beneficiaries to become self-sufficient and rebuild their lives once they complete their rehabilitation journey. “We receive them and give them a sense of belonging when they come; we let them feel loved and valued.”
Bassey-Eyo was admitted to the surgery camp on two occasions. The first was in August 2023, during which she underwent repairs for VVF and was trained in hairstyling. She returned in November 2023 for an RVF repair and was discharged after a 14-day stay.
Unlike her, Itoro Sunday, 29, learned that she was suffering from both VVF and RVF just a week after giving birth to her first child—a baby who sadly did not survive due to obstructed labor in January 2019. In April of the same year, she received surgery and enrolled in a year-and-a-half program at the Family Life Center aimed at helping her regain stability. There, she received clothing-making training and is set to complete her program later this year.
Obotama says the chances of survival for babies born during obstructed labor are very slim. “It is uncommon for babies to survive in these situations. For instance, after prolonged labor, only about 2 out of 100 babies might pull through due to the delays in their delivery.”
The Nigerian government is actively working to improve services with the establishment of three National Obstetric Fistula Centres. Various state-funded VVF centers also exist in other regions, with some support from missionary hospitals across the country.
Obotama emphasizes that if these policies are effectively implemented, they could address the significant backlog Nigeria currently faces. “These policies will also foster a supportive environment for a comprehensive approach to combatting fistula in far-to-reach Nigeria,” she stated.
By collaborating with other Catholic organizations and partnering with federal governments, The MMM sisters’ program helps improve health care accessibility in low- and middle-income countries, or in communities where many people live below the poverty line. Perhaps this could serve as a comprehensive model for other health services in other underserved communities.
Image: Pexels/Shedrack Salami
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