For most vulnerable Nigerian women, high rates of traumatic birth injury

MAIDUGURI, Nigeria – “One week after I delivered my second child, I realized that there was an issue,” Aisha told UNFPA from her hospital bed in Maiduguri, in north-east Nigeria. She had developed an obstetric fistula, a devastating childbirth injury that can derail a woman’s whole life.

Obstetric fistula occurs during prolonged, obstructed labour. The obstruction can create a hole between the vaginal wall and the bladder or rectum, leading to incontinence – and often stigma, shame or even rejection from families and communities.

“I am now worried to mix with people,” Aisha said. “I am so disturbed by this. I love my husband but he is so disturbed too.”

Obstetric fistula is a major public health problem in Nigeria.

According to a 2010 report by EngenderHealth, an estimated 400,000 Nigerian women and girls suffer from fistula, and approximately 12,000 new cases occur annually.

This injury afflicts society’s poorest and most marginalized – those without access to emergency obstetric medicine.

The humanitarian crisis in the north-east has exacerbated these conditions; a significant majority of the country’s fistula cases take place in the north.

A broken system

Aisha was 12 years old when she got married, and 14 by the time she delivered her second child.

Her situation is not uncommon.

Women and girls in the region face high rates of child marriage and early pregnancy, which is part of the problem. Pregnant adolescents have a higher risk of experiencing fistula because their bodies may not be ready for motherhood.

“Early childbirth, a lack of skilled birth attendants, unavailability of comprehensive emergency obstetric care services and poor access to family planning are the main factors contributing to obstetric fistula,” said Dr. Diene Keita, UNFPA’s Representative in Nigeria. “All of these factors are very prominent in the north-east.”

Fistula is preventable – with speedy access to medical care such as Caesarean section – and it is treatable with surgery.

“Opportunities for fistula repair surgery exist in North-East Nigeria,” Dr. Keita said. “However, due to the ongoing conflict, health facilities in rural areas have been destroyed or damaged, and the referral system to operating hospitals and the outreach programme, to make women aware of the surgery, are broken.”

Beyond reach

Fistula surgery costs roughly $300 to $420, which puts it beyond the reach of most of those afflicted.

And because the condition only affects vulnerable women and girls, and is not considered life-threatening, it is often not prioritized.

Every year, UNFPA’s Campaign to End Fistula supports approximately 1,200 fistula repair surgeries in Nigeria.

“We see that the surgery is very important,” said Asabe Christopher Mshelia, a nurse-midwife in the fistula unit of Maiduguri State Specialist Hospital, where UNFPA is supporting upgrades. “Not only for the individual woman but also as a pull factor for other women and girls to seek help. If a woman goes back to her community after a successful surgery, the good news travels and inspire others to come forward.”

UNFPA is also working to improve access to emergency obstetric care in emergency settings. And the government has also adopted policies to help prevent and eliminate this injury.

But much more remains to be done.

Today, Aisha is on the waitlist for a repair surgery at the Maiduguri State Specialist Hospital. Despite her troubles, she is confident about the future.

“I want to go back to my husband and have more children after the surgery,” she told UNFPA. “But I might advise my younger sisters to wait with marriage and children because I learned here that being a young mother can cause this issue of fistula.”

– Anne Wittenberg