United States Agency for International Development (USAID) in partnership with Federal Ministry of Health and Ministry of Women Affairs has estimated that about 160,000 to 200,000 women develop Vesicovaginal Fistula (VVF) every year. Vesicovaginal Fistula and Rectovaginal Fistula (RVF) are holes resulting from the breakdown in the tissue between the vaginal wall and the bladder or rectum caused by unrelieved obstruction during labour causing continuous involuntary discharge of urine (urinary incontinence). The consequences related to these conditions may also include dermatitis, erosion of the skin and other tissues in the vulva and vagina with constant leaking of urine and faeces. Also, in extreme cases, nerves at the lower limbs can be damaged which may lead to loss of coordination.
Historically, cases of VVF date back to the earliest existence of humans. It was an especially rampant problem between the 17th and 19th centuries in much of what is now the developed world. In fact, in 1855, the world’s first VVF specialist hospital was established in New York, United States of America. Everywhere in the world, VVF is a social and economic scourge, as many women with the condition are regarded as social outcasts, deprived of their fundamental rights and privileges as they are left on the streets, or in deserted places far away from family and associates.
In most cases of VVF, there is a lethal obstruction during child delivery that causes prolonged childbirth as the unborn child is pressed tightly against the pelvis, cutting off blood flow to the vesicovaginal wall, which kills the tissue and makes a hole. According to experts, 90% of VVF is caused by unattended labor, and is especially common in women delivering for the first time.
VVF is responsible for over 55%-60% of divorce cases in Nigeria alone, as the VVF patient is enveloped by offensive odours resulting from the smelly nature of the condition. Teenagers are highly susceptible to VVF due to their small pelvic sizes. This is why it is unsurprising that it is very common in the northern parts of the country where early marriage is a norm which naturally results in early conception by the young bride. A VVF expert in the region has investigated how so many young girls lose their lives during childbirth, and how the ones that survive the ordeal are left almost incapable of conceiving ever again. Nigeria has been said to account for 40% of VVF cases in the world. This makes it a very big health concern for the country.
Experts have argued that the major cause of VVF is illiteracy as it is prominent in rural areas filled with uneducated women who have little or no access to information and adequate health care services. Recent research has established that most women prefer to give birth in traditional maternity centers than in proper health institutions. This is one of the biggest reasons for the high rate of VVF in Nigeria as ill-equipped and unskilled medical personnel are more likely to tear through their wombs, press hard on their abdomens and make so many other unhealthy choices. National Demographic Health Survey in 2012 estimated that every year in Nigeria, 12,000 more women will develop vesicovaginal fistula and only 5,000 will seek medical intervention and probably undergo surgery. Experts believe that by year 2015, these figures will double to at least 2 cases of VVF per 1000 pregnancies.
Despite the fact that VVF is most prominent in childbearing, it has also been discovered to result from cases of violent rape and female genital mutilation. Conscious efforts have been made by the government and non-governmental organisations to combat this scourge with quite a number of VVF centers established in the northern parts of the country where it is most prevalent. However, it is still worth mentioning that these efforts have to be stepped up as these centers still remain underfunded. To improve maternal health, awareness should be created as to the importance of antenatal care for pregnant women to easily detect early cases of VVF when it can be easily cured; a service they won’t get from traditional maternity centers. Educational materials should be produced to create this awareness and primary health networks provided to the rural areas where poor uneducated women can easily have access to VVF treatment is achieved by surgery and rehabilitation. This intervention package should also focus on repairing the mental, social and economical damage women suffer from VVF. These will be very vital to reducing the rate at which Nigerian women continue to suffer from a scourge that can be controlled and easily prevented.
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