Addressing Obstetric Fistulas, for improved maternal health
As the MDGs draw to an end, it is no longer news that Nigeria, an oil-rich nation, with a population of over 170 million people, still lags behind, and ranks 2nd worst on the global maternal mortality index, albeit with little progress in the reduction of preventable maternal deaths, over the past decade. Unfortunately, women are not only dying in childbirth from preventable causes; some survive, but with devastating conditions that affects not only their health but their lifestyle. One of such conditions is obstetric fistula.
Globally, approximately 2 million women live with obstetric fistula, and over 40% of them are in Nigeria, alone. Obstetric fistula, simply put, is an abnormal opening in a woman’s birth canal that mainly results from obstruction in the passage of the fetus during labor, otherwise known as obstructed labor. This opening can be between the rectum and the vagina, but mostly occurs between the bladder and the vagina, causing involuntary leakage of urine from the vagina. However, the consequence of obstetric fistula, which is preventable and treatable, goes beyond the leakage of urine and skin infections; it is debilitating and undermines the existence and dignity of an affected woman, because this condition leaves her ashamed, stigmatized and ostracized from families and communities, due to the smell of urine that trails her wherever she goes.
Unlike in developed countries, obstetric fistula still occurs in developing countries like Nigeria as a result of a tragic combination of harmful practices like female genital mutilation/cutting (FGM/C); poverty,; culturally-induced child marriage, that inevitably increases the rate of childbirth among girls whose pelvis are not matured for this wonderful process that brings forth a life; and a weak health system that is struggling to provide adequate skilled birth attendants, quality maternal health services and, most importantly, emergency obstetric care, for women in labor. According to the Secretary-General of the United Nations, Mr. Ban Ki,oon, obstetric fistula, which is a preventable condition, has been turned into a devastating one in poorer countries, due to the combination of inadequate medical care and stigma. .
As a silent but major childbirth-related complication bedeviling our country, obstetric fistula has received little attention in the several efforts to improve maternal health. Amidst efforts to end obstetric fistula in Nigeria, by development partners, spearheaded by the UNFPA, End obstetric fistula Campaign, launched 2003, there is a National five-year (2010 - 2015) strategic framework for the elimination of obstetric fistula in Nigeria that calls for the full integration of obstetric fistula services into sexual and reproductive health services, and evidence-based care of obstetric fistula through prevention; improvement in reproductive, maternal and emergency obstetric services; and rehabilitation and reintegration of affected women.
Nigeria has the largest treatment center for vesico-vaginal fistula (VVF) in the world, situated in Katsina State (in northern Nigeria); and the federal government has endeavored to make all treatments free. Other national VVF treatment centers are in Bauchi and Abakaliki, not forgetting State-based centers in Ibadan, Ilorin, Akwa-Ibom, Jos, etc. Since 2013, the Federal Ministry of Finance, following the President’s directive at the time, provided funding for the correction of over 2,000 VVF cases. This was continued into 2014, where over 2,000 cases were also repaired. Unfortunately, there has been no similar funding allocation in 2015.
However, beyond the treatment and rehabilitation of affected women and improvement in emergency obstetric services, is the need to address the root cause of this condition, through but not limited to subverting harmful practices and cultural beliefs that encourages child marriage; empowering girls and young women; bridging the gender inequality gap; and ensuring access to universal health coverage. As we move into the era of the Sustainable Development Goals, there is a renewed hope that strategies adopted to holistically improve maternal health may address some of these interventions, for improving obstetric fistula.
The Wellbeing Foundation Africa
World Health Organization. 2015. Improving access to high quality care for obstetric fistula. http://www.who.int/reproductivehealth/topics/maternal_perinatal/fistula-study/en/
WHO. 2015. 10 facts on obstetric fistula. http://www.who.int/features/factfiles/obstetric_fistula/en/
AHMED S, O.TUNCALP. 2015. Burden of obstetric fistula: from measurement to action. The Lancet Global health. Vol 3, No 5 http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70105-1/fulltext
BABATUNDE OSOTIMEHIN. 2014. Seizing the moment to end obstetric fistula. The Lancet Global Health. Vol 2, No 7. http://www.thelancet.com/journals/langlo/article/PIIS2214-109X (14)70251-7/full text
FMOH. 2012. National Strategic Framework for the elimination of obstetric fistula in Nigeria 2011 – 2015. http://www.fistulacare.org/pages/da/files/5/5.4/Nigeria_National_Strategy_2011-2015.pdf
SNEHA BAROT. 2011. Eliminating Obstetric Fistula: a comprehensive approach to a long-ignored problem. RH reality Check. http://rhrealitycheck.org/article/2011/01/25/eliminating-obstetric-fistulacomprehensive-approachlongignored-problem/