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Fistula, a silent tragedy for child brides

Fistula patients at the Danja Fistula Center, Niger

Until recently, I thought I knew all there was to know about a woman’s struggle on the path to motherhood, after all, I had trudged it myself. It had taken determination, 7 uterine fibroid surgeries, a miscarriage and a battle with pre-eclampsia before my daughter was born, two months early. Today she is a thriving, strong and delightful 6 year-old.

Then I met Hadiza, a sweet 16 year-old who was married to her uncle at 9, pregnant at 12 and developed an obstetric fistula after prolonged labour and her baby’s death. She was one of 63 fistula patients at the Danja Fistula Center in Niger with whom I spent a week in February. Hadiza is recovering from her 4th fistula surgery a month ago and lives in hope that she will be « dry » again.

Fistula is a condition that affects hundreds of thousands of women, sadly 90% of them in Africa. Their story, like that of Hadiza, is one that hardly gets told.

The tragedy of obstetric fistula for women and girls in Africa

An obstetric fistula is a childbirth complication due to obstructed labour when the tissues between a woman’s vagina and her bladder or rectum are damaged from the continuous pressure from the baby’s head stuck in the birth canal. The dead tissue falls off resulting in a hole through which the woman continuously leaks urine or faeces or sometimes both.

The tragedy of a fistula patient begins when she goes into labour. Try as she might, the baby won’t budge. Hours pass, days even and her suffering continues. She is in a remote village with no midwife or access to medical attention. Added to her physical pain and suffering is the mental anguish of a lack of information about her situation. Her baby dies inside her and has to be extracted, sometimes piece by piece.

Hadiza, child bride and fistula patient in Nigeria

Hadiza learns embroidery as part of a social reintegration programme at Danja,

With her dead child goes her dream of motherhood and that desperate ache and incomprehension that accompanies every woman who has miscarried or lived through the birth of a still-born child. Then her second tragedy begins. She can’t understand why she is leaking urine or faeces or worse still, both.

Soon she gets used to the constant drip of her bodily wastes down her leg and to the strong smells she emits. Her husband sends her home to her parents. In some cases, her smell becomes so unbearable, even her parents put her out, consigned to a hut far from the house, sometimes having access to others only when food is passed to her, in some cases, using a shovel to maintain distance.

Child brides, a group vulnerable to fistula

One of the populations most vulnerable to fistulas are young brides. Child marriage is a global problem with an estimated 12 million girls given out in marriage before they turn 18, some as young as 9. 14 of the 20 countries with the highest rate of child marriage are in Africa.

The toxic combination of a young girl having sex, getting pregnant and going through childbirth when her body is not developed enough accounts for at least 25% of known fistula cases.

You do not have to have a daughter to imagine the impact of child marriage. It cuts across countries, cultures, ethnicities and religions. These children are robbed of their childhood, denied their rights to health, education and security, trapping them in the vicious cycle of poverty. And yet these decisions to hand out girls in early marriage are mostly taken by those who should be responsible for protecting them – their own parents and guardians – sometimes in the name of tradition.

I spent 7 hours in the Operating Room observing 4 corrective surgeries at Danja. It costs about $450 to give a woman her life and dignity back. But repairs, important as they are, will not eradicate fistula. Programmes are needed that reach communities to dissuade them from marrying their daughters as children.

Fistula is 100% preventable. So is child marriage

National prevention strategies to prevent new cases of fistula that focus on innovative community-based approaches have to be implemented. There are few better models than that of Health Development International (HDI) Norway, which is currently being implemented by the Government of Niger as part of its National Program of Reproductive Health.

Repairs, important as they are, will not eradicate fistula. Programmes are needed that reach communities to dissuade them from marrying their daughters as children.

Civil society, community and faith-based organisations, businesses, multinational organisations, schools and individuals must play a role too. This is why some of us are working tirelessly with partners such as Girls Not Brides to raise awareness of these social ills that plague our women and to prioritise adolescent girls. We partner with the Fistula Foundation to raise funds to pay for free fistula surgeries, train African fistula surgeons, and to support and implement fistula prevention and reintegration programmes worldwide.

Fistula is 100% preventable. So is child marriage. Until we can guarantee the human rights of our girls and women, we, as Africans, and our governments are only paying lip service to development.

A longer version of this post appeared in the Life and Style section of ThisDay newspaper, Nigeria, on June 2, 2013.