Childbirth, Then Exile: The Silent Fistula Crisis

         

     

By HALIMA TAKWAS

How broken primary healthcare, poverty, and silence are condemning rural women to lives of pain

An investigative editorial from rural Niger State

A life undone by childbirth

WHEN Sheituna Saani speaks about her condition, her voice barely rises above a whisper. Not because she is weak, but because years of shame have trained her to disappear.

“When they told me about the sickness, I cried and prayed that Allah should just take my life,” she said.

Mrs. Saani developed obstetric fistula after a prolonged labour that went untreated in her rural community. Doctors later told her the condition could be cured through surgery, but the cost—running into hundreds of thousands of naira—placed recovery far beyond her reach.

Referred to a hospital in Kaduna, she returned home defeated. With no money for treatment, she turned to local herbs. Instead of healing, her condition worsened. Constant urine leakage caused nerve damage in her legs, leaving her struggling to walk.

The physical pain was only the beginning.

Stigma as punishment

As the smell from constant leakage grew impossible to hide, neighbours withdrew. Her husband soon followed.

“He sent his friend to tell me he was no longer interested in our marriage,” she recalled.

Mrs. Saani was returned to her parents’ house—divorced, impoverished, and socially erased. In her community, fistula is often treated as a moral failing rather than a medical injury.

“They call me a smelly woman. If they see me coming, they go another way,” she said.

Her story is not exceptional. It is routine.

A familiar tragedy, repeated

In 2021, Zainab Shefiu, then 21, entered labour in a village with no functional health facility. After hours of obstructed labour, her twins were stillborn. Days later, she noticed she was leaking both urine and faeces.

She had developed both vesicovaginal fistula (VVF) and rectovaginal fistula (RVF)—a devastating double injury caused by prolonged labour.

“I became like a baby who couldn’t control herself,” she said. “I stopped going out.”

Her husband disappeared. Her parents became her caregivers.

What fistula really reveals

Obstetric fistula occurs when prolonged labour creates a hole between the birth canal and the bladder or rectum. While entirely preventable—and curable—it remains widespread in Nigeria.

The United Nations estimates that 40 per cent of global fistula cases occur in Nigeria, with 13,000 new cases recorded annually. Up to 90 per cent of affected women lose their babies, often during stillbirth.

Fistula is not just a medical issue. It is evidence of a system that fails women at every stage—before pregnancy, during labour, and after injury.

The roots of neglect

Medical experts point to a deadly mix of factors:

• lack of skilled birth attendants

• long distances to emergency care

• early marriage and teenage pregnancy

• chronic malnutrition that stunts pelvic growth

Despite laws banning child marriage, nearly 30 per cent of Nigerian girls are married before 18, particularly in northern regions.

“This injury is not an accident,” said obstetrician Akinde Joseph. “It is the predictable outcome of a broken maternal health system.”

Government promises, slow relief

Nigeria’s 2019 plan to eliminate obstetric fistula by 2023 failed, hampered by poor funding and weak implementation. A renewed push—the Fistula Free Programme—now offers free surgeries through selected hospitals.

As of January, 1,629 women had been treated, but over 100,000 remain on waiting lists.

Repair campaigns alone cannot solve a problem created by neglect.

More than survival

For women like Mrs. Saani, fistula means more than illness—it means exile. Until Nigeria fixes rural healthcare, ends child marriage, and invests in skilled maternity care, thousands of women will continue leaking in silence.

This is not fate. It is failure.