AN INVESTIGATION INTO THE SOCIOECONOMIC IMPACT OF OBSTETRIC FISTULA ON WOMEN IN NORTHERN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

An obstetric fistula is a severe and avoidable maternal health disorder marked by a perforation between the birth canal and bladder or rectum, caused by prolonged obstructed labour. Primarily, it is a result of insufficient medical attention during delivery, especially in areas with minimal resources. Approximately 2 to 3 million women worldwide are now burdened with untreated obstetric fistula, with a substantial number living in sub-Saharan Africa, notably Nigeria (Fistula Foundation, 2021). Obstructive fistula is a significant public health concern in Northern Nigeria, worsened by socio-cultural factors, poverty, and restricted healthcare access. The incidence of obstetric fistula in Nigeria is documented to reach up to 2,000 new cases year, with the northern areas exhibiting the greatest rates (Bashah et al., 2022). Insufficient prenatal and postnatal care, limited availability of experienced birth attendants, and early marriage are among the factors that contribute to this high occurrence. Preference for traditional birth procedures in many cultures results in a higher likelihood of obstructed labour and subsequent development of fistulas (Kassebaum et al., 2016). Moreover, persistent poverty significantly limits the availability of essential healthcare services, such as urgent obstetric treatment, which plays a vital role in averting obstetric problems. 

The socioeconomic consequences of obstetric fistula on women are significant. Women affected by this condition frequently endure considerable physical and mental anguish, resulting in social rejection and seclusion (Aldoh et al., 2021). The physical constraints imposed by the impairment prevent many women from participating in economic activities, resulting in a loss of income and heightened reliance on their family (Mason et al., 2016). This financial strain goes beyond the individual, impacting not just families but also broader communities. The diminishment of a woman's capacity to earn may have catastrophic consequences on the annual income of a home, especially in areas where women's economic contributions are crucial for the survival of the family. Furthermore, apart from the economic ramifications, obstetric fistula also has profound repercussions for emotional well-being. Accompanied by social isolation and stigma, women afflicted with this disorder often experience melancholy, anxiety, and diminished self-esteem (Akinwunmi et al., 2021). The psychological strain is intensified by the physical health complications linked to fistula, including persistent discomfort, vaginal incontinence, and susceptibility to infections. Although obstetric fistula has severe repercussions, there is a significant dearth of knowledge and dissemination of information about this ailment among healthcare professionals and the general populace in Northern Nigeria. A significant number of women lack knowledge about their medical condition, the treatment alternatives at their disposal, and the need of obtaining medical assistance (Afolabi et al., 2020). Furthermore, cultural beliefs and customs related to birthing might provide obstacles to obtaining prompt and suitable healthcare assistance. Sustained efforts have been made in Nigeria to tackle obstetric fistula, with many organisations undertaking programs focused on prevention and therapy. Nevertheless, there is still a lack of comprehensive knowledge about the socio-economic consequences of this disease on women in Northern Nigeria.  Therefore, the researcher sought to investigate  the socioeconomic impact of obstetric fistula on women in Northern Nigeria.

1.2 Statement of the problem

Obstetric fistula is a severe ailment that mostly impacts women in underdeveloped nations, especially in Northern Nigeria, where the occurrence is remarkably high as a result of multifaceted socio-economic causes. This disorder, often resulting from very lengthy obstructed labour, gives rise to substantial physical, social, and psychological difficulties for women who are affected. In spite of the existence of surgical repair options, a significant number of women do not get treatment owing to limited access to healthcare facilities, socio-cultural shame, and poverty (Wall, 2006). The socio-economic consequences of obstetric fistula in Northern Nigeria go beyond personal distress and significantly impact families and communities. Individuals diagnosed with obstetric fistula often experience social exclusion, resulting in reduced social standing and financial insecurity. Inability to work or participate in social activities leads to reduced income and heightened reliance on family members (Mason et al., 2016). Moreover, the high occurrence of early marriage and substandard educational attainment among women in this area increases the likelihood of obstetric problems, hence reinforcing the cycle of poverty and marginalisation (Doherty et al., 2014). Although previous research has examined the medical components of obstetric fistula, there is a lack of extensive evaluations that specifically investigate its socio-economic consequences on women in Northern Nigeria. Hence, the study investigate the socioeconomic impact of obstetric fistula on women in Northern Nigeria.

1.3 Objective of the study

The broad objective of the study is to investigate the socioeconomic impact of obstetric fistula on women in Northern Nigeria. The specific objectives is as follows

To assess the prevalence of obstetric fistula among women in Northern Nigeria

To examine the causes of obstetric fistula among women in Northern Nigeria.

To investigate the socioeconomic impact of obstetric fistula on women in Northern Nigeria

To proffer strategies aimed at improving maternal health services in Northern Nigeria

1.4 Research questions

The following questions have been prepared to guide the study

What is the prevalence of obstetric fistula among women in Northern Nigeria?

What are the causes of obstetric fistula among women in Northern Nigeria?

What are the socioeconomic impact of obstetric fistula on women in Northern Nigeria?

What are the strategies aimed at improving maternal health services in Northern Nigeria

1.5 Significance of the study

Findings of the study  will be significant to the ministry of health as it will provide valuable insights into how obstetric fistula affects not only women's health but also their economic well-being, quality of life, and societal integration. This knowledge can help healthcare practitioners and policymakers design better maternal health interventions. In addition, the study will be significant to the academic community as it will contribute to the existing body of knowledge and also serve as a guide to future researchers.

1.6 Scope of the study

The study focus on  the socioeconomic impact of obstetric fistula on women in Northern Nigeria. Empirically, the study will assess the prevalence of obstetric fistula among women in Northern Nigeria, examine the causes of obstetric fistula among women in Northern Nigeria, investigate the socioeconomic impact of obstetric fistula on women in Northern Nigeria and proffer recommendations aimed at improving maternal health services in Northern Nigeria.

Geographically, the study will be delimited to Gagarawa LGA, Jigawa State.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraints are: 

Time: The researcher encountered time constraint as the researcher had to carry out this research alongside other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study

1.8 Definition of terms

Obstetric Fistula: A medical condition characterized by an abnormal opening between the birth canal and the bladder or rectum, caused primarily by prolonged and obstructed labor without timely medical intervention.

Socio-economic Impact: The effects that a condition or event has on both the social and economic aspects of an individual's life.

Early Marriage: The practice of marrying before the age of 18, which is common in some cultures. In the context of Northern Nigeria, early marriage is a contributing factor to the prevalence of obstetric fistula, as young girls often experience complications during childbirth due to underdeveloped bodies.

Maternal Health: The health of women during pregnancy, childbirth, and the postpartum period. It encompasses both the physical and mental well-being of mothers. Poor maternal health services can lead to complications such as obstetric fistula.

Stigma: A social phenomenon where individuals are discredited or devalued based on a particular condition or circumstance. In the case of obstetric fistula, women often face stigma due to the continuous leakage of urine or feces, which makes them socially isolated.

Access to Healthcare: The ability of individuals to receive necessary medical services in a timely and affordable manner. In this study, it refers to the availability of skilled birth attendants, surgical repair services for fistula, and post-operative care in Northern Nigeria.