- About 80 to 95% Obstetric fistula cases occur when a young woman experiences prolonged obstructed labour without access to a Caesarean section – UNFPA
- More than 400,000 women remain untreated in Nigeria annually- UNFPA
- Nobody wants to be identified with fistula – not even the government – Nurse David
By Kazeem Akolawole
Obstetric fistula continues to negatively impact the social and mental wellbeing of women living in Nigeria giving rise to poor maternal health outcome.
While the World Health Organisation (WHO) recommends the introduction of psycho-social interventions in the management of obstetric fistula women, psycho-social support for women living with obstetric fistula in Nigeria are limited.
Midwife Nurse Victoria David affiliated with a Non-Governmental Organization (NGO) working on Obstetric Fistula in Abuja, Nigeria, explains to the Africa Health Report, AHR, that the major cause is obstructed labour which can cut off blood supply to tissues in the woman’s pelvis. When the dead tissue falls away, the patient is left with a hole which is called a fistula, in medical terms – in the birth canal.
Further according to David, sexual violence or rape, female genital mutilation, accidents – falling astride, RTI, gynecological cancers; such as cervical cancer, congenital as well as infections like Lymphogranuloma venereum are key drivers of obstetric fistula in Nigeria.
Cost Implication of Obstetric Fistula Treatment
David discloses that fistula management is not free in Nigeria. Although Nigeria’s federal government has designated health facilities in the Northern region of the country that mostly provides care but she says it is not relatively free. Also there are some NGOs that fund the management of fistula for free.
According to a study conducted by the United Nations Population Fund (UNFPA), the estimated average cost of obstetric fistula repair is around 500 dollars per woman
“The study on cost of fistula repair conducted in Nigeria and Ethiopia, recommended the adoption of the costing tool to provide cost estimates for direct costs associated with fistula care, hospitalization and transport
The study also recommends that the implementation and monitoring of the national strategic framework for the elimination of obstetric fistula should be ensured so as to achieve the main goal of 30% reduction in the backlog of untreated cases, the incidence of obstetric fistula, rehabilitation and reintegration of the repaired needy fistula patients by 2023.
This, the study says, will result in a framework that aligns the global vision of ending fistula by 2030 and will be consistent with achieving a Nigeria-free obstetric fistula.
Nigeria’s Unsatisfactory Obstetric Fistula Treatment, Prevention
Nurse Midwife David attributes the unsatisfactory state of obstetric fistula treatment and prevention in Nigeria to the fact that nobody wants to identify with the disease.
Her words: “Nobody wants to be identified with fistula – not even the government. Yes there is a Fistula desk unit in the Federal Ministry of Health but the government – both federal and state levels have no fund allocation for obstetric fistula”.
She however says that sustainable treatment of obstetric fistula can be effectively upscaled to impact morbidity figures if the federal government can take the lead in ensuring treatment sustainability by budget allocation to the treatment sustainability.
She also lists support training of fistula surgeons with good remuneration and increased awareness and demand generation on the treatment availability and prevention.
Obstetric Fistula Statistics in Nigeria
According to UNFPA data, each year some 50,000 to 100,000 women sustain obstetric fistula in the act of trying to bring forth new life.
According to the global population body, “It is the most devastating of all pregnancy-related disabilities and Nigeria accounts for 40% of fistula cases worldwide”.
UNFPA further states that approximately 80 to 95% of the causes of Obstetric fistula occur when a young woman experiences prolonged obstructed labour and has no access to a Caesarean section.
The UNFPA data further reveals that, “The obstruction can occur because the woman’s pelvis is too small, the baby’s head is too big, or the baby is badly positioned. She can be in labour for five days or more without medical help. The baby often dies and if the mother survives, she is left with extensive tissue damage to her birth canal.
“The results are life shattering. She is unable to control the flow of her urine or faeces. Nerve damage to her legs also makes it difficult to walk. Rather than being comforted for the loss of her child, she is often rejected by her husband, shunned by her community and left to live a life of shame and isolation. If she remains untreated she might die pre-maturely from an infection or failed kidney.
“Obstetric Fistula is a preventable and treatable condition, one that no woman should have to endure. Yet more than 400, 000 women remain untreated in Nigeria. Annually, UNFPA repairs about 3, 000 fistula cases but a lot more still needs to be done”.
