According to UNICEF, between 400,000 and 800,000 Nigerian women live with obstetric fistula.
Maryam Abubakar had been in labour for days. She had endured the pains but there was no childbirth facility in her neighbourhood.
The 26-year-old mother of two dreaded the interstate trip to a health facility because it would intensify her pain.
But as her condition became more desperate, she finally accepted to embark on the 70-kilometre trip from her hometown, Nguru in Yobe State, to Hadejia in Jigawa State.
Hours after she arrived at Jahun General Hospital in Jigawa, she had a stillbirth through cesarean section. Doctors at the facility later told her that due to her prolonged labour, she had vesicovaginal fistula (VVF).
According to one of the oldest and globally recognised medical journals, Lancet, vesicovaginal fistula (VVF) is “a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool.”
Ms Abubakar said after she was admitted to the fistula section of the hospital managed by Médecins Sans Frontières (MSF), which translates to Doctors Without Borders, her husband divorced her.
“When I was told about my condition, I was terrified and cried like I had never done in my life. The doctors pleaded with me and gave me hope that they will treat me and return my life to normal. But I am disturbed because I am aware that women with VVF are stigmatised,” she said.
“While still being treated at the hospital, my husband called me and said he needs a new car, which is an idiom that he wanted to marry a new wife. This was days after he stopped visiting the hospital or calling to check on me.
“He said he could no longer eat the food I cook because of my condition,” she said crying.
After she was discharged, (by which time her husband had married another woman) she spent two months with her parents while she waited to be certified VVF-free. After she was certified as being completely healed following corrective surgery, she prepared to return to her husband.
Ms Abubakar said she wore decorative traditional henna on her legs and hands and was set to return to her husband when he called asking him to wait for a message. He subsequently sent her a message divorcing her.
She said her life took a difficult turn after her health challenge. She said she is now stigmatised in her community and would-be suitors stay away from her upon learning of her battle with VVF.
Prevalence of VVF in Nigeria
VVF is one of the most devastating maternal diseases in Nigeria. Approximately two million women were estimated to be living with unrepaired vesicovaginal fistula (VVF) and about half of the total from developing countries were from Nigeria.
It is considered one of the most serious and tragic childbirth injuries that often lead to depression, social isolation and deepening poverty. It is prevalent in Nigeria due to the existence of some cultural practices including child marriage, female genital mutilation and poor access to healthcare facilities.
According to the United Nations Children’s Fund (UNICEF), between 400,000 and 800,000 Nigerian women are living with VVF and between 50,000 and 100,000 new cases are added every year.
The United Nations agency said Nigeria has a prevalence of obstetric fistula, as VVF is also known, of 3.2 per 1000 births. It bemoans the slow rate of fistula repairs caused by inadequate fistula surgeons and the high rate of new cases.
The agency estimated that it may take up to 83 years to clear the backlog of cases at the current rate of repair.
At the Jahun General Hospital where MSF renders free surgical repairs VVF in women from Northern Nigeria and the neighbouring Niger Republic, 532 women with the condition were treated in 2021 and 2022.
More fistula patients recount ordeals
Shema’u Muhammed from Bauchi who got her fistula repaired in the Jahun hospital said the rupture was caused by prolonged labour and how she could not get a professional medical personnel to attend to her following a long strike by doctors.
“I could not get medical attention in my community because doctors were on strike. I started the labour one certain Sunday morning but because there were no doctors in the Darazo hospital, I was referred to Bauchi Teaching Hospital (in the state capital). I was attended by doctors on Tuesday, and I delivered through cesarean, unfortunately, I lost the baby.
“My complications worsened for about six days after the surgery, my stomach was swollen like a bubble. It later burst and there was water all over the ward. My bladder was infected. I was later referred to the Jahun hospital, where MSF treated me for free, and I am now okay, but life will no longer be the same,” she said.
She said after she had an obstetric fistula, she was stigmatised by community members, and her husband divorced her and married another wife.
“I have a child with my husband. He later married a new wife. After she delivered a baby, my husband was instructed to divorce me because his family believed that I could no longer conceive. The marriage has ended because of my health condition.
“I am now assisting women who found themselves in my conditions. I am travelling across northern states and even to the Niger Republic to counsel women facing stigmatisation due to obstetric fistula,”
Underage marriage
According to a United Nations survey, 43 per cent of Nigerian girls are married before they are 18. The problem of early marriage is particularly endemic in the North-east and North-west regions of the country.
With more than 80 per cent of girls married before their 18th birthday, Jigawa State has one of the highest prevalences of child marriages in the country.
Under the Child’s Rights Act 2003, the minimum legal age of marriage is 18 years. The act covers vital aspects of the lives of children and adolescents. It is divided into survival rights, development rights, participation rights, and protection rights.
Jigawa is among the Nigerian states that have domesticated the legislation. It, however, expunged the section that regulates the age of marriage for children.
In the state’s version of the Child’s Rights Act, parents are allowed to decide the marriage age of their children. Thus, the law in Jigawa still does not protect girls from underage marriage.
Aishatu Suleiman-Jahun, the head of the Baba Azumi Foundation (BAF), a non-governmental human rights organisation, said in Jigawa State, violence against person prohibition law penalises female genital modulation – one factor responsible for the Obstetric Fistula in the state.
“A person who cut a female genital and a person that hires another to cut a female genital will be sent to prison for a minimum of six months or pay a fine of a minimum of N10,000 or both.
“A person that attempts to cut the genitals of a female and a person that assists or counsels another to cut the genitals of a female will be punished with community service,” Mrs Suleiman-Jahun, a barrister, said.
27-year-old Binta Manu, from Jahun Local Government Area of Jigawa State, who got married at 14, told our reporter how she got affected by the fistula in her eighth child delivery.