It seemed like a strange place for a meeting.

We had just parked on a side street in Kayes, Mali, and climbed out of the car. It wasn’t until we rounded a corner and stepped into a wide alley that we found the group we were scheduled to meet, and I saw why we needed such a big space.

More than 60 women and girls, ranging from grandmothers to teenagers to infants in arms, were there waiting for us. They rose to their feet, smiling and gesturing to the plush couches they’d set out for the guests. Once we were all settled, the group’s president, Tamaratou Samaké, stood and turned to us.

“We are called Nieta,” she said. “It means to move forward, to be progressive.”

And they’re not kidding.

Nieta is made up of dozens of friends, neighbors, and activists united in a cause: to help Mali’s women and children. They want to end child marriage, eliminate female genital mutilation, and promote sex education and family planning. They want to see zero new cases of obstetric fistula in Mali and to help any woman or girl who’s already living with it. They travel around Kayes and the surrounding region talking to groups, educating communities, and urging pregnant women to get prenatal care and deliver their babies in health facilities.

They instill the same values in their girls and create openings for mother-daughter discussions that may otherwise never happen.

On Sundays, they get together to pick up trash from the streets.

They often bring their daughters with them. This way, they say, they can instill the same values in their girls and create openings for mother-daughter discussions that may otherwise never happen.

Like the period talk. (“They need to understand that just because you’re entering a new phase of life doesn’t mean your body is ready for children,” one mother said.)

Or the contraception conversation. (“We’re happy to be able to talk openly with our mothers,” one daughter said. Reading between the lines, I think I understood what she was saying: It’s awkward, but it’s happening.)

Nieta doesn’t provide medical services, but they’re a crucial link in the health care chain in Mali. They dispel myths about family planning and female genital mutilation, and urge families not to let their daughters marry until they’re at least 18. (“If a man loves a girl, he should be able to wait,” Samaké said.)

And they often find women with obstetric fistula—a debilitating childbirth injury—and help connect them to surgical repair campaigns like the ones IntraHealth International’s Fistula Mali project holds in Kayes, Koulikoro, Sikasso, Gao, and Bamako, where we’ve treated over 1,400 women with fistula over the past decade.

Finding these clients is huge. Too often, women with fistula live alone or in hiding, and locating them can be the hardest part of providing them with care. That’s one of the reasons we don’t even know how many women have obstetric fistula, though the World Health Organization estimates 50,000-100,000 women are affected every year.

By working with IntraHealth and our local partner in Kayes—the International Association for Maternal and Neonatal Health in Mali, or IAMANEH—Nieta members could play a key role in eliminating fistula in their own back yards.

Six children per woman

Mali has one of the highest fertility rates in the world. Each woman gives birth to about six children, on average. And the evidence is everywhere. Babies, toddlers, children, teens. I’ve never seen so many kids in my life.

This year marks the 50th anniversary of the 1968 International Conference on Human Rights, which was the first time family planning was globally acknowledged to be a human right. « Parents have a basic human right to determine freely and responsibly the number and spacing of their children, » the Tehran Proclamation said.

In Mali, Nieta and other women are taking it one step further, not only promoting that right throughout their communities but also seizing the opportunity and responsibility to educate their children, particularly their daughters, about what it means to grow up and how to take care of themselves as they do.

IntraHealth’s Fistula Mali project is funded by the US Agency for International Development. Our local partners include the Medical Alliance Against Malaria; Women Action Research, Study and Training Group; and the International Association for Maternal and Neonatal Health.

By Margarite Nathe

Published on 07-10-2018 on Vital