Bridging gaps in maternal health

As of 2025, it is estimated that more than 2 million women worldwide live with untreated obstetric fistulas, with most cases occurring in Asia and sub-Saharan Africa. This serious birth injury is caused by prolonged, obstructed labor and lack of timely medical care. In April, Baylor Medicine urologist Dr. Rotimi Nettey traveled to Malawi as part of the Baylor College of Medicine and Texas Children’s Hospital Global Health Network, contributing to efforts to address this critical health issue.

Located in southeastern Africa, Malawi is one of the world’s least developed countries. The country’s economy is largely rural and dependent on agriculture, which can limit access to healthcare. The government spends less than $14 per year on healthcare expenditures.

“You have women living far from metropolitan and healthcare centers,” Nettey says. “When they go into labor, they often have to travel long distances to receive care. If they labor for days, they may never get the medical attention they need, or if they do, it’s often too late. By then, the process leading to a fistula is already in motion.”

In collaboration with Freedom From Fistula Foundation (FFFF), an organization that provides care for women living with obstetric fistulas at the Fistula Care Centre located on the grounds of Bwaila Hospital, Nettey worked alongside the Global Women’s Health team led by Dr. Jeffrey Wilkinson, vice-chair of Global Health and professor of obstetrics and gynecology, and, Dr. Ennett Chipungu, obstetric fistula surgeon with FFF.

The effects of obstetric fistulas are not only physical. Due to the leakage and odor, women with this condition are also shamed and ostracized, and face high rates of divorce. About 90% of obstetric fistula cases are accompanied by the stillbirth of the baby that caused the fistula, only adding to the pain that these women face.

“One of the intriguing things about the fistula center in Malawi is the model that they’ve set up for providing care using screening, diagnosis and surgical management, in addition to social reintegration services,” Nettey says. “The services are targeted to reintroduce individuals with fistulas back into society and equip them by helping them develop trades and teaching them to plant trees and food. When they go back to their villages or communities, not only are they fixed in terms of their fistula, but they are equipped to become economically productive members of society.”

Programs like this are instrumental in creating pathways for change. Prevention plays a crucial role in this fight. Educating women about the importance of prenatal care and providing access to it is just as vital as supporting existing systems by training healthcare providers in fistula repair.

Focusing on both education and access ensures that women receive the necessary care to prevent complications. Additionally, by equipping healthcare providers with the skills needed for fistula repair, it strengthens the support systems already in place. This dual approach not only addresses immediate healthcare needs but also fosters long-term improvements in maternal health.

Reflecting on the experience, Nettey shared, “It was a reminder of why I went into medicine – to care for people surgically. There are constraints in those settings, so for someone who has practiced western medicine in the era of technology and diagnostic testing, it takes a lot to mentally shift from that framework. I think it is a good challenge for us to see and remember how to rely on our clinical diagnostic skills. There is a lot to learn. Learning is a very collaborative process, and I feel like there were a lot of things I could offer as far as my expertise, but there were a lot of things that I learned from them, too. Knowledge sharing is always beneficial at any level.”

By Alexandria Brown, senior marketing associate in the Scott Department of Urology