The United States Agency for International Development states that Obstetric Fistula (OF) occurs when complications during delivery result in a hole between the mother’s birth canal and either the bladder or rectum — usually exacerbated by a lack of quality medical treatment.
According to United Nations Population Fund, OF is marked by incontinence of urine, faeces or both, adding that the main types are vesicovaginal fistula (connection between the bladder and vagina) and recto-vaginal fistula (connection between the rectum and vagina).
It further noted that Nigeria contributes about 150,000 cases to the estimated global burden of 2,000,000 cases with 12,000 new cases occurring every year.
Despite the high number of cases in Nigeria every year, little is known about this childbirth injury. To bridge the knowledge gap, SNTK chats with Barbara Madu, the co-founder of the Fistula Care Initiative formerly known as the VVF Initiative on how her organisation is tackling the misconceptions about OF through advocacy.
Kindly share what Fistula Care Initiative is all about
The Fistula Care Initiative is a non-profit organization focused on Obstetric Fistula. We raise awareness on the subject through our different online and offline campaigns, raise funding for fistula repair surgeries and also develop programs that help reintegrate fistula survivors into the society.
From 2018 till date, I would say we have reached more than 5,000 women in all.
What experience led to the creation of the organisation?
It is a personal story for me. So, back in my university days, I wrote articles as a side hustle and on a particular day, I was contracted by a dear friend to write for a women’s health magazine. Now, the magazine wanted something different and I was to come up with the topic myself. That was where I discovered Obstetric Fistula. It was a shocker to me, the fact that this illness existed and no one was talking about it was surprising.
There, I decided I was going to have a platform dedicated to raising awareness on Obstetric Fistula and its root causes. Fast forward to Law school in Yola, Adamawa State, I met my friend and cofounder, Nkasike Gbana who also had similar interests and together, we reached out to a few likeminded individuals who turned out to be our founding members. We started off with an online campaign that was widely received and then Fistula Care Initiative was birthed.
I always say that as a group, we never really started out to have an organisation, we just wanted to raise awareness and from that singular act, we discovered we could actually do much more, so here are we.
What problem, in the area of Obstetric Fistula, is Fistula Care Initiative solving?
Majorly, ignorance. A lot of persons are ignorant of the subject. Even some persons who suffer the illness may not exactly know what it is. In this line, we have encountered persons with different myths regarding the subject, it remains our duty to enlighten them. Obstetric Fistula is mostly referred to as a disease of poverty, it is therefore no wonder that this ignorance is prevalent. Even among the educated, the story is no different.
Earlier on this journey, I conducted a survey and interviewed almost 200 students from a particular university and was surprised that out of all, just a handful had heard of the illness.
Please share with us the common misconceptions people have about OF?
Oh, we have seen quite a few, first off, Obstetric Fistula is not a curse from God; it is a medical condition that can be cured. Also, we have heard of cases of women branded as witches as a result of the illness. You know what happens in Obstetric Fistula is that, the woman leaks urine if it is a vesico vaginal fistula (VVF) or feaces if it is an RVF (rectovaginal fistula) or in some cases, it can be both. As a result of leakages, the woman smells and this can lead to them being ostracised from the community. Now, for someone ignorant of this fact that this illness exists, they try to make sense of the situation, hence the misconceptions.
Another popular misconception is that only women who get pregnant at a very early age (maybe as a result of child marriage) could develop fistula; fistula can happen to women at any age as prolonged and obstructed labour which is one major causes of fistula is not age specific. While teenage mothers run a major risk of contracting fistula as a result of their immature pelvises, women who attend centers run by unskilled birth attendants also run similar risks.
How does this ignorance/misconceptions impact on maternal health?
Imagine the statistics; almost 800,000 new cases happen every year and it is bound to continue unless more drastic measures can be taken. Personally, I feel that if obstetric fistula gets the awareness it should have, we would have succeeded in reducing this number drastically. It is important for both women and men alike to understand this condition, its root causes and how to successfully prevent this from happening to women.
In what ways does Fistula Care Initiative tackle this problem?
To address these problems, we conduct campaigns both online and offline talking to different persons. The end goal being to raise awareness on the subject.
Counselling is one aspect that has become a major part of our work as we sometimes receive calls to reach out to some women either living with or have undergone surgeries that are depressed as a result of the disease. I am grateful to our amazing team and partners that help to make all of these possible.
We also raise funding to support women living with this illness and also the hospitals where specialised repair surgeries are carried out.
How do you think Nigeria can quickly end Obstetric Fistula?
It would take a collective effort. The government, international government bodies, and organizations such as ours would have to come together to tackle this issue. Policies addressing root causes of fistula such as early marriages, harmful traditional practices like Female Genital Mutilation etc. should be created to further the cause. Affordable healthcare should also be made accessible to communities.
For Nigeria to successfully eradicate fistula, these factors should be considered and adhered to while continuous awareness on the subject continues.