Women who have recovered from fistula, a childbirth injury that causes incontinence, offer great hope for other victims by breaking taboos, Australian singer and anti-fistula campaigner Natalie Imbruglia says.
About two million women in Africa and Asia live with fistula, which occurs when prolonged and obstructed labour opens a hole in the delicate tissue between the womb and the bladder. The babies almost always die and the mothers start leaking urine.
An estimated 800,000 of the victims are in Nigeria, Africa's most populous country, where Imbruglia has concentrated her efforts since she became the spokesperson for the UN Population Fund's campaign to end fistula in 2005.
"It's not a very glamorous illness and a lot of people might shy away from that, so I thought it was very important to give these women a voice," the Australian entertainer told Reuters in Lagos at the end of her third visit to Nigeria.
"I've seen incredible change in two years. In terms of the numbers of women treated I saw a massive improvement," she said.
Imbruglia, who personally raised STG570,000 ($A1.33 million) over the past 13 months for fistula projects in Nigeria, said one promising new strategy was to train women who have recovered to reach out to other victims.
Fistula mostly affects poor, uneducated women living in remote areas and they are often ostracised by their husbands and communities because they do not understand the condition.
Under a pilot program funded with money raised by Imbruglia, 10 women who have recovered from fistula after surgery have been trained to teach other women in their communities that it is preventable and treatable.
"I met two women, one had fistula for 25 years and the other for 27 years, and now they have become advocates and I spoke with two other women who miraculously have decided to have the treatment after talking to them," Imbruglia said.
The pilot program is part of a three-year campaign launched in August in the northern states of Kano and Katsina, which are among the worst-affected. Free surgery has been provided to dozens of women and more than 100 community educators have received specialised training.
"In the communities I visited it seemed like a very open conversation. The taboo has been lifted," Imbruglia said.
"I was encouraged to see dozens of women who had received treatment who were so excited about it and were coming out to talk about it," she said.
Anti-fistula campaigners say one of the problems is the attitude of many husbands, who do not understand why their wives become incontinent and suspect them of being somehow to blame.
Under the new campaign, male community educators have been sent out to educate more than 700 men about the condition, including 70 religious and traditional leaders.
In poor, predominantly Muslim northern Nigeria, many girls married in their early teens are at high risk of getting fistula because their bodies are not fully grown when they give birth.
Campaigners say it is crucial for men as well as women to understand the risks associated with childbirth.
The UN's official target for the eradication of fistula is 2015, in line with the target for the Millennium Development Goals, but campaigners recognise this is unlikely to happen.
"It may not happen in my lifetime. ... But I am extremely hopeful for the future," said 32-year-old Imbruglia.
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