Closing the fistula is only the first step. Without economic empowerment, social reintegration, and community acceptance, many survivors remain vulnerable. After surgery, women often return to the same conditions that led to their injury – poverty, dependency, and limited opportunities. Without income, some struggle to rebuild their lives. Without awareness, stigma follows them home. This is why fistula must be addressed not only as a medical condition, but as a social and economic issue.
In many parts of northern Nigeria, childbirth is still a test of survival. For thousands of women, it ends not with celebration, but with silence, shame, and abandonment. This silence has a name: Vesicovaginal Fistula (VVF). VVF is one of the most severe forms of obstetric fistula, an injury caused by prolonged or obstructed labour, without timely access to skilled obstetric care. It creates an abnormal opening between the bladder and the vagina, leading to constant leakage of urine. In some cases, women also experience faecal incontinence when the rectum is involved. Women living with VVF often smell constantly of urine. They are mocked, isolated, divorced, or sent away from their communities. Many withdraw from public life entirely. Some stop attending religious gatherings. Others abandon their livelihoods. A number fall into deep depression, believing their condition is incurable. One woman I met in Jigawa State told me she cried endlessly and lived in overwhelming anxiety, convinced that her life had ended. She said people warned her never to hope for recovery because “no one comes back from this illness.” That belief is wrong but it persists.
A Preventable Injury, A Persistent Crisis
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Globally, obstetric fistula remains one of the most neglected maternal health conditions. It disproportionately affects poor, young women in low resource settings, where early marriage, limited access to emergency obstetric services, and weak health systems intersect. Nigeria carries one of the heaviest burdens of fistula in the world. This is not because Nigerian women are biologically different, but because too many still give birth without skilled care, timely referral, or access to Caesarean sections when labour becomes obstructed. According to international health agencies, the vast majority of fistula cases occur after labour lasts two to three days, sometimes longer, without intervention. By then, pressure from the baby’s head cuts off blood supply to surrounding tissues, causing them to die and leave a hole behind. This injury does not happen in isolation. It reflects the systemic failure of health systems, of social protection, and collective responsibility. Yet, despite the scale of the problem, fistula remains hidden. Women suffer quietly, often for years, believing there is no cure or fearing further stigma if they speak out.
Jahun: Where Healing Begins
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At the MSF supported fistula centre in Jahun, Jigawa State, a different story is unfolding. There, women receive free, high quality surgical care, psychosocial support, and counselling. Many arrive withdrawn and ashamed. Over time, they begin to smile again. They regain confidence. They regain hope. Some women return months later pregnant. Others come back with children in their arms – living proof that fistula is treatable and curable. One woman explained how seeing former patients return healthy and strong convinced her to seek care. Another shared that she had met women who used income from small businesses to pay for transport back to the hospital for follow up care. These stories challenge one of the most dangerous myths surrounding fistula: that recovery is impossible. But surgery alone is not enough.
Ending vesicovaginal fistula in Nigeria is possible, but it requires more than surgery. We need stronger maternal health systems with skilled birth attendants at every level, timely referrals and access to emergency obstetric care, and community education to dismantle stigma. Economic empowerment is essential to support survivors’ reintegration, and sustained partnerships between government, NGOs, media, and communities are critical to drive lasting change.
Healing Does Not End in the Operating Theatre
Closing the fistula is only the first step. Without economic empowerment, social reintegration, and community acceptance, many survivors remain vulnerable. After surgery, women often return to the same conditions that led to their injury – poverty, dependency, and limited opportunities. Without income, some struggle to rebuild their lives. Without awareness, stigma follows them home. This is why fistula must be addressed not only as a medical condition, but as a social and economic issue. Through the Africa Health Communication Fellowship, our team worked to bridge this gap by integrating skills acquisition into fistula recovery. Survivors were trained in liquid soap production, air freshener making, and local pasta preparation practical – marketable skills suited to their communities. These skills do more than generate income. They restore dignity. They give women agency. They help survivors redefine themselves not as patients, but as entrepreneurs, mothers, and contributors to their families. One woman proudly explained that she now earns enough to support herself and no longer depends entirely on others. Another shared that the skills gave her the confidence to reenter community life. This is what holistic healing looks like.
The Power of Awareness and Storytelling
Despite the availability of treatment, many women still do not seek care because they simply do not know help exists. In our engagements with communities, religious leaders, traditional birth attendants, and women’s groups, one message stood out: information saves lives. Radio programmes, community dialogues, mosque announcements, and survivor testimonies remain some of the most effective tools for reaching rural populations. When women hear stories in their own language – Hausa or Fulfulde – stigma weakens, fear fades, and hope grows. Health communication is not an afterthought; it is a core intervention. Journalists and health experts have a shared responsibility to tell these stories accurately, ethically, and with compassion. Not as sensational tales of suffering, but as evidence that systems can work when women are supported.
A society cannot claim progress while women are hidden away for an injury sustained while giving life. Nor can healing be complete if survivors return to lives of dependency and silence. The women of Jahun show us what is possible when care is compassionate, comprehensive, and rooted in dignity. Healing a woman means more than closing a wound. It means restoring her voice, her livelihood, and her place in society.
A Call for Integrated Action
Ending vesicovaginal fistula in Nigeria is possible, but it requires more than surgery. We need stronger maternal health systems with skilled birth attendants at every level, timely referrals and access to emergency obstetric care, and community education to dismantle stigma. Economic empowerment is essential to support survivors’ reintegration, and sustained partnerships between government, NGOs, media, and communities are critical to drive lasting change. Fistula is not just a health failure it is a development failure, and addressing it demands a comprehensive, collaborative approach.
A society cannot claim progress while women are hidden away for an injury sustained while giving life. Nor can healing be complete if survivors return to lives of dependency and silence. The women of Jahun show us what is possible when care is compassionate, comprehensive, and rooted in dignity. Healing a woman means more than closing a wound. It means restoring her voice, her livelihood, and her place in society. Until every woman can give birth safely and every survivor can rebuild her life fully our work remains unfinished.
Amogi Endurance Friday is a Health Informatics and Data Systems Specialist with APIN.
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