[:en]According to the WHO, for every woman who dies of pregnancy-related causes, 20 or 30 others experience acute or chronic morbidity that undermine their normal functioning. One of the morbidities is called Vesico Vaginal Fistula or VVF.
According health experts, VVF is caused mainly by long hours of obstructed labour, which in turn ruptures the soft tissues in a woman’s cervix, making her leak urine or faeces through her vagina uncontrollably.
Nigeria is home to nearly half of the global cases of VVF. There are presently nearly 800,000 cases of women with VVF in Nigeria and at least 20,000 new cases occur annually. Many of these women are young teenage girls who are given out in marriage and become pregnant before their physical structure is ready to withstand the rigours of labour. The United Nations Fund for Population Activities-UNFPA says 110 women die every day in Nigeria from pregnancy-related complications. Indeed, the 2013 Nigeria National Demographic Health Survey puts Maternal Mortality Rate at 350 per every 100,000 live births, accounting for 14% of global maternal deaths.
Principally, women who suffer VVF are poor and often live in rural areas, where access to quality emergency care during delivery is nearly absent. Once VVF sets in, they become social outcasts, ostracised by the community and many have to live in facilities.
Such facilities, six in number across Nigeria, are able to repair only 3,000 cases annually, meaning there is an annual backlog of nearly 17,000 cases of women waiting for their dignity to be restored.
This reality calls for urgent action by Nigeria, to key into the three strategic messages in the UNFPA global campaign to ‘End Fistula’, which are: prevention of new cases; treatment for those already with fistula; and reintegrating them back into their communities. There are however, low hanging fruits Nigeria can harvest to ensure that women and girls reach their full potentials and do not die or sustain debilitating injuries just to birth another child.
For one, preventive measures must be put in place. In this regard, Nigeria can immediately and equitably deploy more skilled birth attendants to all the primary health care facilities in the country and scale-up the Midwives Service Scheme, so as to reduce mortality and morbidity by 90%.
Another measure is to strengthen Nigeria’s health system as part of a long-term plan and as envisioned by President Muhammadu Buhari in his inaugural address to the nation. Health authorities must also ensure that health workers are deployed based on a needs assessment and conditions of service are made favourable enough to entice those who would be posted to work in rural, hard to reach areas.
In addition, government should as a priority, provide the three million dollars funding it pledged in 2011, for the procurement of contraceptives and to improve the distribution chain. A partnership between government, religious and community leaders can help to address issues of early marriages and teenage pregnancies. More accessible enlightenment and access to modern contraceptives will also be beneficial in the short to long term.
Nigeria has the largest National Fistula Repair and Training programme in the world. The programme’s lead surgeon, Dr Kees Waaldijk, has performed over 20,000 fistula surgeries during the last 28 years and is considered one of the foremost fistula surgeons globally. In collaboration with Dr Waaldijk, government, the UNFPA and other international agencies, can provide free surgeries for women who can not afford such surgeries on their own.
Experts estimate that it cost about 420 dollars to manage one woman with fistula. In reality, many women are too poor to even transport themselves and pay for other services required for their surgeries. It is in this regard and in educating the larger society against stigmatising women its VVF that the contributions of civil society groups and non-governmental organisations will be most valuable.
These measure will no doubt help to limit the rising cases of VVF, alleviate the suffering of those living with the condition and in the final analysis, restore the dignity of VVF patients, before, during and after undergoing treatment. Undoubtedly, these young Nigerian women and girls deserve no less from all and sundry.