Fatima's story: How family planning is changing lives

Fatima Abba Bukar, who is now expecting her fifth child

One year ago, the Trump administration's decision to reinstate the 'Mexico City Policy' (aka the 'global gag rule') raised concerns for the healthcare of women and children across the world.

CARE’s experience across the world to provide development and humanitarian assistance indicates that this misguided policy is dangerous and puts lives at risk. It results in reduced access to vital family planning services, the closure of health clinics and the poorer health of women and children.  

Organisations like CARE are fighting back. CARE's programme in Northeast Nigeria provides healthcare to women who have fled violence from Boko Haram - women like 25-year-old Fatima Abba Bukar, who has a remarkable story.

Fatima was woken by shouting and blood-curdling screams in the middle of the night. She told us:

Boko Haram came and started pouring gasoline on the houses. They came with their gasoline and matches. We ran away.

“They were shouting ‘This is the house of Christians’,” said Fatima, who is Muslim. Fatima fled for her life into the bush, disappearing into the darkness as her village burned in the distance. In the chaos, she was separated from her husband and her four sons.

Fatima said her grandfather and nephew were killed that night. But they weren’t her only loss.

In the process of running, I miscarried. I was three months pregnant.

Fatima with her four sons
Fatima with her four sons


Fatima made it to Maiduguri, the largest city in Nigeria’s Borno state, but she had lost an enormous amount of blood and was so ill that she ended up spending several months in the hospital. Eventually she was reunited with her children and, more than a year later, her husband. 

Today, her husband works for months at a time in the bush as a farmhand growing tomatoes, onions and other vegetables. Fatima, meanwhile, is nine months pregnant – her first pregnancy since the miscarriage.

New life

When she discovered one of the maternal health clinics supported by CARE in and around Maiduguri, Fatima’s life changed. The clinic is operated out of a two-room home that a local family donated to the cause after Boko Haram burned down a nearby hospital. More than 40 percent of health facilities in Borno state have been destroyed in the conflict

Fatima says it’s the first time she’s ever received antenatal care, including regular check-ups, free medicine and a CARE “dignity kit” that includes sanitary pads, a bucket and soap for washing, laundry detergent, a cloth wrap and other hygiene items.

The difference between life and death

The clinics also distribute birthing kits, complete with a birthing pad and sterilised blade for cutting the umbilical cord. Home births are a fact of life here because the military imposes a 9pm curfew and many of the women don’t have access to transport.

But for women who do make it to a clinic during the day, CARE can get them to a hospital in the region if they have serious complications. CARE operates four tricycle ambulances – sometimes, the difference between life and death.

Fatima talking to a nurse
The head nurse at one of the CARE-supported clinics in Maiduguri checks on Fatima

Meeting women's needs

The maternal health care needs in northern Nigeria are massive, especially for family planning services, emergency obstetric care and treatment for sexual violence survivors.

Some 1.7 million of the women affected by the crisis are of reproductive age, and over 275,000 women are expected to become pregnant this year, according to the United Nations Population Fund (UNFPA).

In Borno state, the epicentre of the crisis, maternal mortality rates are three to four times higher than the national average.

All the more reason for CARE to rise to the challenge

CARE's programme was launched in August last year, and it plans to make sexual and reproductive health services available to about 450,000 women and girls in the region by the end of 2018. 

Fatima, now 25, said she’s learned about family planning options at the clinic and has already started discussions with her husband, who is supportive of her using birth control in the future and spacing out births. 

But for now, Fatima is focused on giving birth to a healthy fifth child. She said she’s having the red-and-blue cloth wrap from her CARE dignity kit made into matching outfits – one for her and one for her newborn. She says, flashing a wide smile:

We will wear them at the naming ceremony.

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News and stories are provided by CARE staff working to support our emergency responses and long-term development programmes.