Nigeria

In the 1970s and 1980s, the Foundation's work in Nigeria included attention to matters of child survival, family planning, and population research. By the late 1980s, with estimates of the nation's total birth rate at about seven children per woman, family planning had become a priority and began attracting considerable resources from both the government and private donors. Yet little attention was being paid to the extraordinarily high levels of pregnancy-related illness and death throughout West Africa. In Nigeria alone, it was estimated that 75,000 women died every year in pregnancy and childbirth, and for every woman who died, approximately 15 to 20 more women were left disabled, deformed, or diseased.

In 1988, through discussions with representatives of women's organizations, Foundation staff learned of the prevalence of a problem called vesico-vaginal fistula (VVF). VVF is the result of prolonged and obstructed labor in childbirth in young and malnourished women and in women who have had numerous pregnancies. When such labor does not lead to the death of the mother and child—as it frequently does—it often results in the woman's permanent disability. Since women with VVF suffer from incontinence, they are frequently abandoned by their husbands and their families, and must endure a life of social exclusion and poverty, often with prostitution as their only means of survival.

The factors causing VVF are also linked to a host of other reproductive health problems. Those factors include poverty, malnutrition, women's lack of control over their lives, harmful traditional practices, and very early marriage and childbearing. Foundation staff therefore decided to focus on women suffering from VVF.

The Foundation began by funding the Kano State branch of the National Council of Women's Societies (NCWS) in predominantly Muslim northern Nigeria. Members had already raised funds to build a fistula-repair facility in the state hospital, but it lacked trained staff.

Foundation grants to NCWS supported in-service training of local doctors in fistula repair, helped set up a rehabilitation program to train affected women in income-generating skills, and launched a community awareness campaign in Kano State. NCWS worked through the local emirs—powerful traditional Islamic leaders—to educate male district and village heads about the dangers of early marriage and