How to eradicate Fistula Problem in Nigeria


New York Times, which is believed in some quarters to be the number two leading daily newspaper in the world in its September 28, 2005 edition carried a very shocking and mind boggling news story about Nigeria on its front page written by SHARON LaFRANIERE . The Story entitled “Nightmare for African Women: Birthing Injury and Little Help narrated the ordeal women are suffering in Africa, particularly Nigeria when it comes to pregnancy and delivery which are all natural phenomena that are suppose to occur uneventful.  The writer mentioned amongst others that Obstetric fistula in Nigeria is indeed a nightmare, unknown in the West for nearly a century. Mostly teenagers who tried to deliver their first child at home, the girls failed at labor. Their babies were lodged in their narrow birth canals, and the resulting pressure cut off blood to vital tissues and ripped holes in their bowels or urethras, or both.


Now their babies were dead. And the would-be mothers, their insides wrecked, were utterly incontinent. Many had become outcasts in their own communities - rejected by their husbands, shunned by neighbors, too ashamed even to step out of their huts.


Until this decade, outside nations that might be able to help effectively ignored the problem. The last global study, in which the World Health Organization estimated that more than two million women were living with obstetric fistulas, was conducted 16 years ago.


Nor has a recent spate of international attention set off an outpouring of aid. Two years of global fundraising by the United Nations Population Fund, an agency devoted in part to improving women's health, has netted only $11 million for the problem.

The number of new cases is far outpacing repairs - not just here, but in other sub-Saharan nations like despite recent strides, said Thoraya Ahmed Obaid, the Population Fund's executive director, "at the current rate of action it will take decades to end fistula."


The writer lastly narrated the experience of one doctor practicing Fistula Surgery in northern Nigeria for longa patient who managed to push out only her baby's head before collapsing from exhaustion in her hut, her brother carried her, balanced on a donkey, to a road, where a bus driver demanded 10 times the usual fare to take her to a hospital. She half-stood, half-sat for the trip, her dead baby's head between her legs, her urethra ripped open.


Let me hasten to add that Fistula Problem in Nigeria ( Vesico- Vaginal and Recto – Vaginal Fistulae ) are highly preventable problems as long as our politicians and policy makers will have the political will to make use of the adequate tax payers money in addressing women’s plight in our dear country . Nigeria with an estimated population of 126 million where high fertility rate is valued and a woman’s status is determined by her reproductive capacity with a total fertility rate which remains as high as 5.7 children/woman. Unfortunately, reproduction occurs under conditions that threaten the life and well being of women, resulting in very high level of maternal deaths. Nigeria’s maternal mortality ratio of 948/100,000 with a range of 339/100,000 to 1716/100,000 is one of the highest in the world. For each maternal death that occurs, 15 to 20 other women suffer either short or long term maternal morbidities. Prominent among these morbidities is Obstetric Fistula which the major one is the Vesico- Vaginal – Fistula (VVF).


The commonest cause of VVF in Nigeria is Obstructed and Prolonged Labor   and this account for between 80 to 95 % of all the cases seen. VVF resulting from obstructed labor occurs when a young woman with prolonged labor due to cephalo-pelvic disproportion and cannot get timely Caesarian Section to relieve the obstruction. Other cause of VVF which is also common is Gishiri Cut, a traditional cut done by Traditional Birth Attendants to increase the size of the private part of a lady during labour when there is obstruction.


In Nigeria  about 400,000  800,000 Nigerian women are suffering from VVF and majority of them will be found in rural areas where even the primary health care services are grossly inadequate, inaccessible and a times not available at all. Some of the women are young who are not opportune to have even Primary School Education and of course Poverty is also playing a key role in worsening the situation. The scenario is such that, when a woman in a rural setting is in labour, she stays at home for about 2 to 3 days trying   to push, the family or the husband may decide to take her to the nearest hospital, on reaching there, no facilities and equipments for emergency obstetric procedures and a times no competent personnel to handle the situation. All these problems culminated in to the scenario of continuously having cases of VVF, particularly in northern Nigeria where the policy makers capitalize on the high illiteracy rate and lack of awareness of their electorates about their right to Health, Education, Good Roads and Water and other basic amenities to perpetually mis-appropriately squander and embezzle federal allocation meant for developmental projects.


As we have read  earlier on that “Two years of global fundraising by the United Nations Population Fund( UNFPA ) an agency devoted in part to improving women's health, has netted only $11 million for the problem. As a development agency that operates offices in Nigeria and Africa as a whole, I highly expected such agency to use that meager resources to engage various tiers of governments through sustain advocacy , meetings and dialogue  to ensure Health Sector Reform towards improved service delivery to be providing timely and emergency obstetric care, meeting the un-met needs of contraceptive services and massive awareness raising campaign through Radio and Television  on the importance of Ante Natal Care.


Unfortunately, that was not the case by the UNFPA and its collaborators, looking at the previous experience. In February /March 2005 the agency and the government of Kano, Katsina, Sokoto and Kebbi organized what they termed as Fort Night Campaign on Obstetric Fistula, where they conducted massive surgical repair of fistula in those states within two weeks.  I strongly believe that will not change the situation , it was rather a window dressing and publicity seeking campaign  that will not reduce the prevalence of VVF in Nigeria , it is like addressing the sequelae of Obstructed Labour not the cause of it . In conclusion, it is really sad and consternating to note that addressing Fistula Problem in Nigeria is within our capabilities as long as our leaders and the followers are willing to work together towards collective survival strategy and I sincerely hope we shall continue to draw the attention of our Governments and their International Development Partners to do the right thing at the right time in addressing the plight of women in Nigeria.


Dr Magashi is the Executive Director of Community Health and Research Initiative, Kano , Nigeria and can be reached at