Obstetric fistula is a childbirth injury that should be a thing of the past, yet over one million Nigerian women live with it. Caused by prolonged, obstructed labor without timely medical intervention, it leaves women incontinent—often abandoned by their families, shunned by their communities, and struggling with deep emotional scars.
Bashir Foundation for Fistula and Women’s Health (BFFWH) is working to change that. Since its founding in 2018, the organization has provided free surgeries, education, and empowerment programs to help women regain their dignity.
In this conversation, we speak with the foundation’s executive director, Barakat Adewale, about the challenges, triumphs, and what needs to happen to eliminate fistula in Nigeria.
Obstetric fistula is preventable, yet it persists. What are the main contributing factors?
Obstetric fistula is a condition that’s pretty much a thing of the past in developed countries, but it’s still a huge problem in many developing nations. What’s note-worthy is that these countries often face similar challenges.
First, there are socio-cultural factors—home births without skilled attendants, teenage pregnancies, and harmful traditional practices like female genital mutilation (FGM). Economic struggles also play a role: poverty, weak healthcare systems, and a shortage of skilled medical professionals make it harder for women to access care.
Security challenges also prevent women from reaching hospitals in time for emergency obstetric care, and a lack of education and awareness means many women don’t even know what fistula is or that it’s treatable. On top of all this, stigma and shame prevent affected women from seeking help.
Beyond the physical effects, what are the emotional and social struggles these women face?
The isolation is devastating. Many women with fistula are abandoned by their husbands and shunned by their communities. It’s common for them to struggle with depression and anxiety, feeling like they’ve lost their worth.
Think about it—if someone you love is constantly leaking urine and carrying that smell, would you want to live or work with them? That’s the harsh reality these women face. Even after treatment, many fear rejection and struggle to rebuild their lives.
Financially, it’s just as tough. Many lose their jobs due to their condition, and for those who seek treatment, the costs can be overwhelming. The impact ripples out, affecting their families and communities.
You founded the Bashir Foundation in 2018. What inspired you to take on this cause?
During my master’s in public health at Obafemi Awolowo University, I first heard about obstetric fistula. I couldn’t believe it was real. It sounded like something out of a nightmare. But what shocked me even more was how common it was in Nigeria.
When I visited a fistula center in Zaria, I met incredible women whose lives had been completely upended by this condition. I kept asking myself: Why should bringing life into the world come at such a devastating cost?
It broke my heart to realize that this was entirely preventable—and yet, so many women suffered simply because they didn’t know fistula existed or where to get help. Even as a public health student, I had never learned about it. That was a wake-up call.
I became obsessed with raising awareness. I couldn’t stop talking about it—to my classmates, my friends, and eventually, my brothers. They became my co-founders, and together, we launched the Bashir Foundation for Fistula and Women’s Health.
How did the community react to your work in the early days?
At first, there was a lot of skepticism. Many people didn’t believe fistula was a real problem, just like I didn’t when I first heard about it. In northern Nigeria, where we operate, early marriage is a sensitive issue, and some community leaders denied that fistula even existed in their regions.
But as we started treating women, the impact became undeniable. Families saw their daughters, wives, and sisters regaining their dignity. Some of the women we treated even became our ambassadors, sharing their stories and educating others.
We also started inviting community leaders to our programs. It’s one thing to hear about fistula, but it’s another thing entirely to see the suffering firsthand. Over time, we built trust, partnerships, and a growing movement to end fistula.
Early marriage and adolescent childbirth are major risk factors. How do you approach cultural reform?
Cultural change takes time, but it’s crucial in the fight against fistula. In many communities, early marriage is seen as a way to protect family honor. But the reality is that young girls’ bodies aren’t ready for childbirth, and the risks—including fistula—are enormous.
We work directly with community leaders, religious figures, and parents to shift this narrative. Education is key—when families understand the dangers of early childbirth, they’re more likely to delay marriage and prioritize girls’ education.
We also focus on economic empowerment because poverty is a major driver of early marriage. By providing women and girls with skills and financial independence, we give them more control over their futures.
What are the biggest challenges your foundation faces?
The challenges are huge. Funding is our biggest struggle—many donors prioritize other health issues, so securing sustainable support is difficult.
Reaching women in remote areas is another challenge. Some live in security-compromised regions, making it hard to provide treatment. And then there’s the stigma—many women are too ashamed to come forward, even when help is available.
But despite all this, we’re committed. We find creative ways to navigate these obstacles and keep pushing forward.
What does post-surgery recovery look like for fistula survivors?
Surgery is just the first step. Women need comprehensive post-operative care to heal physically, emotionally, and socially.
Physically, they require wound care, pain management, and bladder rehabilitation. Many have used catheters for weeks or months, so they need help regaining control.
Emotionally, they benefit from counseling and support groups to process their trauma and rebuild their self-esteem.
Social reintegration is also crucial. We involve family and community leaders in the healing process, helping women reconnect with loved ones. Some even reunite with their husbands—though one survivor I’ll never forget proudly told us, “It’s my turn to shine!”
We also provide vocational training and startup capital to help women regain financial independence. Because true healing isn’t just about fixing the body—it’s about rebuilding a life.
With over 500 women treated, can you describe a patient’s journey from diagnosis to recovery?
Imagine being trapped in isolation, believing your life is over. Then, one day, a community volunteer knocks on your door, offering a glimmer of hope—free treatment.
At first, you’re hesitant. Can this really be true? But something inside you stirs, and you decide to take the chance.
Our mobilizers arrange transport, ensuring financial struggles don’t stand in the way. At the hospital, you meet other women like you. For the first time, you realize: you’re not alone.
After diagnosis, surgery is scheduled. You wake up with catheters in place, marking the start of your recovery. Over the next two weeks, you receive care, counseling, and rehabilitation support.
Before you leave, you receive vocational training and financial assistance to help you start over. Finally, you return home—not as the woman who was abandoned, but as a survivor, empowered and hopeful once again.
What’s next for the Bashir Foundation?
2025 is a big year for us! Some of our key initiatives include:
- Project Fix – Expanding free fistula surgeries across Kaduna, Abuja, and Zamfara.
- Women’s Health Circle – A safe space for women to discuss sexual and reproductive health.
- Media Advocacy – Powerful storytelling projects, documentaries, and survivor-led awareness campaigns.
Every initiative brings us closer to a world where no woman suffers from a preventable childbirth injury. We won’t stop until that vision becomes reality.
