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Vesicovaginal fistula in Nigerian women

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By Mercy Kelani

400,000 to 800,000 women in Nigeria live with the medical disorder.

According to Lancet, one of the most globally recognised and oldest medical journals, vesicovaginal fistula (VVF) is a critical medical disorder that features an abnormal opening between the bladder or rectum and the vagina which eventually causes frequent urine or stool leakage. In Nigeria, VVF is regarded as one of the most disturbing maternal diseases affecting women. Estimations have it that about two million women live with unrepaired VVF, while 50 percent of the estimate from second-world countries were from Nigeria.

This injury is one of the most critical and devastating childbirth injuries that oftentimes result in social isolation, depression, and worsened poverty. Its prevalence in Nigeria can be attributed to the practice of some cultural norms which include female genital mutilation, child marriage, and lack of access to healthcare facilities. The United Nations Children’s Fund (UNICEF) stated that about 400,000 to 800,000 women in Nigeria live with the injury, and every year, there is an addition of between 50,000 and 100,000 new cases.

43 percent of girls in Nigeria get married before the age of 18.

UNICEF asserted that Nigeria has a high record of VVF, recording 3.2 per 1000 births. This emphasised the languid rate of fistula repairs caused by inexperienced surgeons and the increasing rate of new cases. The United Nations agency had stated that it might take Nigeria 83 years to reduce the number of cases to the lowest level recorded, given the current rate of repair. However, at Jahun General Hospital, Médicins Sans Frontières (MSF) carries out surgical repairs VVF in Northern Nigerian women and the Niger Republic without fees. In 2021 and 2022, it treated over 500 women with the medical disorder.

Also, there was a provision of antenatal for about 33,900 women, delivery assistance for about 12,500 women, and caesarean section deliveries for about 1,600 women by the facility’s MSF team. Report from a United Nations survey says 43 percent of girls in Nigeria get married before the age of 18. The issue of child marriage especially common in the North-east and North-North-west regions of Nigeria. Currently, Jigawa State has records one of the highest rates of early marriages in the country, with over 80 percent of their girls getting married before 18.

Jigawa State’s law does not protect girls from early & underage marriage.

The Child’s Right Act 2003 affirms that 18 years is the minimum legitimate age of marriage. This Act — divided into survival rights, participation rights, development rights, and protection rights — protects the crucial aspects of children and adolescents’ lives. Although Jigawa State is one of the Nigerian states that has domesticated Act, it omitted the section that affirms regulation of the marriage age for children. The state’s version of the Act allows parents to make the decision of their children’s marriageable age. Hence, Jigawa State’s law does not ensure protection of girls from early and underage marriage.

Head of the Baba Azumi Foundation (BAF), a human rights NGO, Aishatu Suleiman-Jahun, stated that violence against person prohibition law frowns against female genital mutilation with penalties, as a major cause of obstetric fistula in Jigawa. Anyone who cut the genitals of a female and anyone who hires somebody to mutilate a female’s genital area will either be sentenced to prison for a minimum of six months or forced to pay a minimum of 10,000 fine, or do both. Also, anyone who tries to mutilate the genitals of a female and anyone who offers assistance or advises someone else to cut a female’s genitals will suffer the punishment of community service.

Treated women are granted a means of livelihood for independence.

Abdulkareem Yakubu, Head of field communication for the MSF in Nigeria, said that after the surgical repairs on women, a celebration ceremony was conducted as a medium of promoting socio-economic integration of women who have been stigmatised due to their medical condition. They were given flour and spaghetti-making machines to earn them independence and a small business in their homes. Additionally, MSF calls for efforts to assist in the reintegration of affected women into their communities and preventing the injuries through expansion of access to quality maternal care.

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