Combating Vesico-vaginal fistula and Recto Vaginal fistula(VVF/RVF) through girl child education in Northern Nigeria

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VVF Pre operation preparations

VVF Pre operation preparations

vvf

For each maternal death 10 to 20 women suffer permanent injuries or disability during the process of child birth. The most prominent among these injuries is obstetric fistula called Vesicovaginal fistula (VVF). Vesicovaginal fistula constitutes a major gynecological problem in developing countries. It is prevalent in communities where malnutrition and untreated infections stunt the growth of future mothers during their childhood and adolescence leading to contracted pelvis. In Situation where maternity services are scarce or far or even mistrusted contract pelvis go undiagnosed and survivors of obstructed labor may be left with bladder or rectal injuries resulting in constant uncontrollable loss of urine or stool into the vagina.  The women if not treated are likely to suffer consequences ranging from physical disability, psychological, social, and economic consequences. They may also be ostracized from their own community; some become homeless, divorced or abundant by their husbands. The trauma is often compounded by the psychological trauma of delivering a stillborn baby. VVF is a major public health issue in Northern Nigeria where the prevalence is on the raise because of increasing poverty, girls are married off at early (under 19 years), high school dropout and low girl school enrolment are school.

Although the campaign to end VVF in Nigeria is ongoing over the last 20 years, little attention has been paid to prevention of new cases. The government and national foundation of VVF campaign (NF-VVF) and other non-governmental organization have their focused on the repair and treatment of the over 200000 thousand backlog cases. Currently there are 8 VVF centers in Nigeria mostly in the northern states caring for VVF cases. According to Dr Kees Waaldijk over 25000 repairs were performed since the inception of the foundation.  488 health professional trained in the pre and post-operative care for VVF. USAID developed a strategy they called pooled effort for fistula repair, the society of obstetrics and gynecology encourage trained gynecologist to repair and manage VVF cases, the ministry of women affairs in Jigawa state are working in collaboration with USAID to clear the backlog of fistula case. All these efforts are curative and none are preventative efforts.

Neglecting preventive strategies will only make matters worse as new cases add to the backlog every day.  The NF-VVF acknowledges that there are no national VVF policies or policies that support prevention of VVF. Less than 7% of girls are enrolled in school in Jigawa state, followed by large drop after the first year. This is when the girls get married. The girl child has no say over her choice whether to be in school or to be married, that decision is left with the father.

Let us therefore end this mayhem by educating girl child.  Putting girls in school will delay early marriage and delaying marriage will lead to reduction of teen pregnancies hence reduction in pregnancy related complications such as VVF and maternal mortality. Other benefits of girl child education include development of essential life skills, such as self-confidence, the ability to participate effectively in society, and protect themselves from HIV/AIDS, sexual exploitation.  Additionally they will contribute to national wealth, their children are more likely to go to school and, consequently, this will have exponential positive effects on education and poverty reduction, reduction of VVF for generations to come.

References:

http://www.isofs.org/wp-content/uploads/2011/04/report_2010_000_full_report_LR.pdf

htp://www.gamji.com/article5000/NEWS5652.htm

http://www.sogon.org/

http://www.jigawastate.gov.ng/ministry_contentpage.php?miniid=23

http://www.waha-international.org/

http://bixby.berkeley.edu/research/population-and-reproductive-health-partnership-northern-nigeria/girl-child-education/incentives-to-promote-girls-education-in-northern-nigeria/

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5 Responses to “Combating Vesico-vaginal fistula and Recto Vaginal fistula(VVF/RVF) through girl child education in Northern Nigeria”

  1. bsmoker Says:

    Okonkwos, you have identified a public health problem that is very worthy of our attention. Thank you so much for highlighting this issue.

    You mention “the NF-VVF acknowledges that there are no national VVF policies or policies that support prevention of VVF.” A recurring theme throughout the world is that vulnerable populations such as women, children, and the poor are overlooked or ignored. It may be useful to frame VVF within a human rights perspective to encourage the Nigerian government to take a more active role in its prevention rather than its current primary focus on repair and treatment.

    Nigeria ratified the Convention on the Elimination of All Forms of Discrimination Against Women [CEDAW] in 1985 (http://www.un.org/womenwatch/daw/cedaw/cedaw.htm). Article 12 of CEDAW says that states “. . . shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period . . .” Nigeria also ratified the International Covenant on Economic, Social and Cultural Rights [ICESCR] in 1993 (http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx); Article 12 of ICESCR declares that everyone has the right “to [enjoy] the highest attainable standard of physical and mental health.” Finally, in General Comment No. 14 regarding ICESCR (paragraph 21), the UN Office of the High Commissioner for Human Rights (http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En) declares that “The realization of women’s right to health requires the removal of all barriers interfering with access to health services, education and information, including in the area of sexual and reproductive health.”

    The above passage may seem somewhat pedantic, but my purpose is to drive home the point that the Nigerian government, through its ratification of CEDAW and ICESCR, has already declared its commitment to the progressive realization of the rights of women within its borders to attain the highest standard of health; reduction or elimination of VVF explicitly falls within this realm.

    • okonkwos78 Says:

      Thank you bsmoker for you great contribution to the post. I do agree with you absolutely probably reframing the message through proactive behavioral change will make a deifference in the campaign against this mayhem ,the Issue though is there are so many NGOs and other interest groups that are involved currently in either funding or providing skilled care to various projects or programs on VVF but there in total disarray with eachother. Each project has its interest and focus, rasing a huge concern to even the health professionals that provide the direct care. This quickly brings to mine the problem of vertical versus horizontal programs.

      http://fistulacare.org/pages/sites/nigeria.php

      • bsmoker Says:

        Thank you for the reference. You make excellent points. Looks like there’s a tremendous effort already in place in Nigeria to address this.

  2. jackiewallace Says:

    Great blog and discussion. Although VVF is an issue that I’m familiar with, I really appreciate your blog, Okonkwos, as I haven’t thought a lot about the prevention side of the problem. As you point out, prevention should be the ultimate goal! Unfortunately, the obstacles to prevention are many, most importantly that many women are unable to reach a health facility before significant damage has occurred. I see how this issue lends itself to vertical programming, in that there is a defined, fairly successfully cure to a drastic, debilitating problem. However, the vertical programs don’t change the root of the problem- the lack of available facilities to handle complications of birth. I agree that an excellent starting point would be girls education, as preventing child marriage and underage pregnancy would go a long way towards decreasing VVF.

  3. kristenppatterson Says:

    Thank you for the excellent post, Susan. You have effectively highlighted an urgent public health issue that affect girls, women, and their families in many parts of the developing world. Regarding keeping girls in school, innovative financial incentives could help. I have thought that in Niger and Northern Nigeria, girls who complete primary school could be given a goat. Girls who complete secondary school could be given a sheep. These investments would allow them to contribute financially to their families (through the sale or consumption of the animals’ offspring) and incentivize girls and their parents to keep them in school. Also, in the preventive arena, early marriage needs to be addressed, in a culturally sensitive way. It is most dangerous for girls to give birth before the age of 16. Thus, even though international standards are to prevent marriage before the age of 18, focusing on eliminating marriage before age 16 is a good place to start. That way, girls would be much more likely not to give birth before age 17, at which point their bodies would be more developed. In addition, training rural women’s leaders and midwives on the danger signs of obstructed labor could help.

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