Earlier this month, the UN released its final report on the Millennium Development Goals. Progress in MDG 5, improving maternal health, ultimately lagged behind the others. Far too many women in the 21st century are still dying during childbirth, and not enough are delivering in the presence of a skilled birth attendant. For every woman who dies during childbirth, at least 20 more suffer from devastating injuries like obstetric fistula, a condition that results from prolonged obstructed labor and renders a woman incontinent.
So why are so many women delivering on their own, without skilled assistance or emergency obstetric care? Why are women still developing obstetric fistulas, when we know it’s a condition that can be prevented and should no longer exist? Some of the main hurdles are due to poverty – women may live far away from the nearest hospital, particularly in rural areas, and transportation can be too expensive. Still other hurdles have to do with healthcare infrastructure, or, perhaps more appropriately, a lack thereof: for women who do make it to a hospital or health center, the facility might not have the necessary supplies or expertise to help her deliver safely.
Women may also face specific challenges depending on which region they are from. In Nigeria, for example, particularly in the rural northern region, there are a number of barriers that prevent women from accessing treatment. Understanding these barriers is important, as Nigeria has the world’s largest burden of obstetric fistula (estimates start at 10,000 new cases every year) and one of the world’s highest rates of maternal mortality.
In northern Nigeria, early marriage is common, depriving girls of their chance to stay in school and thrive, and women often cannot access health services or medical care without permission and/or the presence of a male relative. If a woman goes into labor while her husband is away, for example, she may have to wait days before she is allowed to receive treatment at a health center.
The Boko Haram crisis adds another layer of difficulty to the situation in northern Nigeria. Fear and insecurity continue to grow as these conservative militants terrorize the region through bombings, kidnappings and other acts of violence. Women may be afraid to leave their homes as a result, preventing them from accessing vital health care services before, during and after childbirth.
In early July, Boko Haram attacked a mosque and restaurant in the city of Jos, claiming nearly 50 lives. Jos is the home of one of our partners, Evangel Vesico-Vaginal Fistula Center. There, heroic doctors and staff work tirelessly in the face of these extreme challenges to restore the health of Nigerian women.
The center’s lead surgeon, Dr. Sunday Lengmang, is passionate about women’s health. After undergoing on-site training, Dr. Lengmang officially joined the Evangel team in 2004 and has since performed hundreds of fistula repair surgeries each year along with his team. He also trains other surgeons and health workers in fistula care, and helped develop a curriculum for midwives on managing labor effectively and preventing fistula.
Staff from the center conduct regular outreach sessions throughout the year, venturing into rural areas to raise awareness about fistula and help identify new patients who may not have known treatment was available. The center has also started a ‘men’s group’ for husbands of fistula patients, who are encouraged to engage in dialogue with their male colleagues on providing care and support to women in the community who are suffering with fistula.
Evangel Center has performed nearly 10,000 surgeries since it opened its doors in 1992. Fistula Foundation is proud to support Dr. Lengmang and the center’s life-changing work!