In most of the western world, childbirth is a relatively celebrated and safe process. Sadly, in many parts of the world, it remains a challenging and even fatal experience for women and girls - especially the most vulnerable.

Our MMM Sisters have always been committed to the care and wellbeing of the mother and child.  Our health care and education efforts still focus on this. 

Tragically each year, more than a quarter million women die in pregnancy and childbirth.  Due to lack of resources or antenatal care, of those who are fortunate to survive in remote and vulnerable areas of the world, an unknown number suffer long-term health problems. The impact of this causes the girls and women physical, mental, social, economic and psychological harm. 

The maternal injury with perhaps the most devastating outcome is obstetric fistula or Vesico Vaginal Fistuala (known as VVF). Reliable statistics on how many women suffer is hard to find, but it is estimated to be in the millions.  It is estimated that over 2 million women in Nigeria alone are waiting for this surgery. At the current rate of care, it will take over 80 years to provide surgery and care for all these women. 

MMM Sisters have been working in pioneering ways to help with this issue which goes beyond being a healthcare matter and is now a human rights issue often overlooked by major global health NGOs.  So, while many people in the western world have never heard of VVF or Obstetric Fistula, it is destroying the lives of millions of women who are in dire need of help.  It is a tragedy as this could be prevented.  To give us the most accurate information we interviewed Sr. Ekaete Ekop, MMM, who is a medical doctor with vast experience working with VVF. 

Why is VVF still so common in Africa?

• Most cases of Vesico Vaginal fistula result as a complication of childbirth: prolonged obstructed labour. This is common in areas of the world where the percentage of women in labour attended to by skilled birth attendants is low. Literature review reveals that it is common in “virtually all of Africa and south Asia, the less-developed parts of Oceana, Latin America, the Middle East, remote regions of Central Asia, and isolated areas of the former Soviet Union and Soviet-dominated eastern Europe.” (Vesicovaginal Fistula, Updated: Nov 11, 2021, Author: John Spurlock, MD; Chief Editor: Christine Isaacs, MD  more...)

• In Nigeria it is common because many women seek care during childbirth outside of medical facilities or in poorly staffed and equipped health centres.

• The aversion for interventional births like Caesarean Section is another reason – so some women stay in labour for too long and only access obstetric services when it is too late.

• Health care in many parts of Africa is mostly out of pocket – so people get only what they can afford. A good percentage of the women – especially in the rural areas – are not able to afford good obstetric care. Many of them get away with having their babies in health care centres that may not be able to provide emergency obstetric care but the few who get into trouble end up with complications like VVF – if they survive.

• Over the years, many governments at state level have tried to provide free maternal care but on the whole this has not been totally sustainable. The health institutions in the country mostly would do better with better governmental support in providing emergency care for the underserved populations.

• Transport to health facilities particularly from a rural area is also a challenge in many parts of Nigeria.

• There are other cultural and religious reasons for VVF. For instance, in some parts of the continent, child marriage still exists.

What do you wish people understood about VVF?

• It is preventable.

• It can be treated.

• It is far better to prevent it than to treat it.

• Good maternal care is the best prevention for VVF.

• The repair of VVF is a highly specialised surgery – only a small percentage of doctors know how to repair it. Also, there is little incentive to specialise in this as these patients can ill afford the treatment. Health care workers need support from the government and other agencies in order to be able to provide this care for women.

• Victims of VVF need not be ashamed or give up hope. There is hope and help for them.

What are the MMMs doing to help women with VVF and to help prevent it?

• First of all, Medical Missionaries of Mary provide maternity services to women to enable them to have safe and hitch-free deliveries.

• Over the years, MMMs have also trained Obstetricians and Midwives to give safe deliveries in line with international best practice standards.

• MMM has a policy where every centre providing maternity services must meet a set of requirements. These requirements include the provision of emergency obstetric services.

• MMM provides specialised comprehensive care for the VVF patients. Our hospital in Itam organises a few camps every year. In these camps, VVF surgeons from around the country come in and provide surgical repair for these patients. The Sisters also provide vocational training and counselling to the patients to help them re-integrate into society. They also give them some financial help for a head start as they graduate from the programme. They include the families in the counselling session.

• We also had a VVF hospital in Uganda and Sr. Maura Lynch, MMM coordinated VVF care for many years – even after we had handed over the hospital to the diocese. 

• Other MMM facilities also run awareness and sensitisation programmes to help women understand the importance of having a skilled birth attendant at delivery.

What can be done to reverse this trend?

• It is more important to put resources into the prevention of this scourge. Even after surgical repair, the woman still has to live with the other handicaps and limitations. Some even need more than two surgeries to achieve dryness while others never achieve dryness even after multiple surgeries. In other words, the problem is not totally solved by surgery.

• Efforts need to be put into sensitisation, policy making at local levels, health awareness, and provision of emergency obstetric care to the underserved areas.

If you would like to know more about VVF and our MMM efforts, please visit our website 

www.mmmworldwide.org. We are eager to raise funds to provide additional resources to prevent and eradicate VVF.