In Nigeria, fight against fistula points to problem of early marriage

ABUJA, Nigeria – Since her marriage at age 14, Zuera Mustapha, now 21, has experienced two stillbirths and a recurrent obstetric fistula resulting from her difficult deliveries. Yet even with these hardships, she has been luckier than some; her mother and sister both died of complications in childbirth. In northern Nigeria, where she lives, fistula and maternal death are alarmingly common – a fact UNFPA is working to change.

“I [developed] fistula after my first delivery. The child had died,” Ms. Mustapha said, simply, from her home area in Kano State.

Obstetric fistula is a hole between the birth canal and the bladder or rectum, or both, caused by prolonged labour without prompt medical intervention, such as a Caesarean section. Affected women suffer chronic incontinence, which can result in stigma and social isolation.

Ms. Mustapha received an operation to repair the problem at the Laure Fistula Centre, one of many centres supported by UNFPA in Kano, and she was instructed to have a hospital delivery during her next pregnancy. “The doctors asked me to return to the Murtala Hospital when I was in labour for a Caesarian section. But the labour started in the middle of the night, so I went to the hospital early the following morning,” she said. Despite receiving a C-section, the fistula recurred.

The Federal Ministry of Health’s National Strategic Framework for the Elimination of Obstetric Fistula estimates that “approximately 20,000 new cases [occur] each year, although recent studies put estimates at approximately 12,000 new cases per year”. The country has a maternal death ratio of between 487 and 545 deaths per 100,000 live births, according to the strategy.

A problem of adolescent pregnancy

The problem is exacerbated by adolescent pregnancy. According to a recent United Nations report, “Researchers have found that girls who become pregnant before age 15 in low- and middle-income countries have double the risk of maternal death and obstetric fistula than older women.”

Adolescent pregnancy too often results from child marriage – which is not only a health hazard but a human rights violation as well. “A significant proportion of adolescent pregnancies result from non-consensual sex, and most take place in the context of early marriage,” the UN report says.

According to the 2008 Nigerian Demographic and Health Survey, “Almost half (46 per cent) of women aged 20-49 were married by age 18.”

Taking action

To address the high incidence of obstetric fistula and maternal death, health officials and policymakers must increase access to fistula treatment and promote interventions that can prevent fistula from occurring – routine antenatal care and delivery under the care of a skilled birth attendant such as a doctor, nurse or midwife. Officials must also work to prevent early marriage.

UNFPA provides funding to the Fistula Foundation Kano, which makes treatment of fistula more accessible in Kano and Katsina states; the treatment is usually provided at no cost. The organization supported the treatment of some 685 fistula patients in 2012 alone, and 201 patients were treated between January and September 2013.

Although the UNFPA project targets six local government areas in Kano and Katsina states in northwestern Nigeria, women from other communities have also taken advantage of the facilities.

“We have 60 trained community mobilizers, who go from house to house, educating women on birth preparedness, antenatal care and hospital delivery,” said Musa Isah, the Director of the Fistula Foundation.

“We also now educate men on how best they can support their wives when it comes to pregnancy and child birth, and at the same time encourage delivery in hospitals,” he added.

A ‘Fistula Ambassadors’ programme is also enlisting women to advocate for hospital deliveries, raise awareness of the dangers of early marriage, and inform women and families about the availability of free fistula treatment.

With support from the Federal Ministry of Health, UNFPA has also carried out maternal health programmes in other parts of Nigeria, including in Ebonyi, Abia and Akwa Ibom states. These programmes address obstetric fistula, as well as other issues, such as emergency obstetric care, family planning, early detection of breast and cervical cancers, and girls’ education.

With reporting by APANEWS.