LAGOS, Nigeria (VOICE OF NAIJA) – Halima (not real name) was just 9 years old when her parents married her off to a 48-year-old man as his fourth wife.
She was too young, and her body was not developed enough to handle childbirth.
At 10, she became pregnant and went into labor when it was due but her small pelvis and undeveloped cervix made it impossible for her to deliver naturally.
She developed Vesicovaginal Fistula (VVF) and became bedridden due to the excruciating pain and neglect from her family.
Tragically, Halima died before her child turned one month old. Her husband quickly married another 9-year-old girl to replace her.
Vesicovaginal Fistula (VVF) is a devastating condition that affects one in seven deliveries worldwide.
In Nigeria, the deplorable healthcare system, financial constraints, and lack of aftercare kits exacerbate the problem, especially in the North-West region where child marriage is prevalent.
A consultant O&G at Ahmadu Bello University Teaching Hospital, Dr. Bilkisu Kankia Lawal shared insights on VVF in a chat with our correspondent, Tanko Lami.
She said: “VVF stands for vesicovaginal fistula, which is an abnormal connection between the bladder and vagina,” she explained.
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The most common cause of VVF is obstetric fistula, which can occur during vaginal delivery, especially in cases of complicated or obstructed labor. When labor is prolonged or obstructed, the baby’s head can press against the vaginal and bladder walls, cutting off blood supply to the tissue.
This pressure can cause the tissue to die, forming a hole, or fistula, between the bladder and the vagina.
In some cases, VVF may also result from the use of instruments to assist in difficult deliveries. Additionally, surgical procedures such as abdominal or pelvic surgeries, and hysterectomies, can cause VVF.
Infections like schistosomiasis may also contribute to its development. When VVF occurs after a surgical procedure, it is considered iatrogenic, as it is caused by the surgery itself.
Early marriage can contribute to VVF, but not because of the age itself; rather, it’s because the pelvis may not be fully developed.
If a young woman becomes pregnant with an underdeveloped pelvis, the baby might be too large to pass through the birth canal, causing obstructed labor.
Furthermore, low socioeconomic status can delay seeking medical help. If the woman does not reach a hospital in time for a Caesarean section, she might undergo prolonged labor at home or in under-equipped health facilities, leading to pressure on the organs and, eventually, fistula.
As for circumcision, if it is not done properly, it can cause VVF. The bladder is located just in front of the vagina, so if a mistake is made during the procedure, it can damage the bladder, resulting in a fistula.
This risk is especially high when circumcisions are performed by individuals without proper anatomical knowledge, like traditional barbers. However, the most common cause remains obstructed labor.
According to her, reports suggest that VVF occurs in about 1 in 7 deliveries, and in Nigeria, it has been reported in up to 2,900 cases per 100,000 deliveries.
“The condition is more common in teenagers, particularly in the northwestern region, with prevalence rates as high as 30% in those under 20 years of age. However, specific statistics may vary by state,” she said.
Asked if the report that suggests that most doctors do not like to perform VVF surgeries, and there are only a few experts in this field is true, Dr. Lawal said the scarcity of trained fistula surgeons could be due to limited training opportunities or a lack of interest in this specialty.
“For example, some doctors may have interests in other areas, such as reproductive health or general gynecology.
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“Additionally, if there are only a few experts available to train others, fewer people will have the chance to specialize in fistula surgery.
“For instance, in Zaria, at the Gambo Sawaba facility, they used to offer free fistula services, but I’m not sure if they are still there,” she added.
Dr. Lawal highlighted the challenges health practitioners face in treating and diagnosing VVF. “The first challenge is often the delay in diagnosis, which is usually due to a delay in presentation.
“Many women with VVF, particularly those with obstetric fistula, come from rural areas with limited access to healthcare.
“They may face economic challenges that prevent them from seeking help immediately,” she added.
Treatment often requires specialized gynecological and urological expertise, and there are very few healthcare professionals trained in fistula surgery.
Dr. Lawal emphasized the need for improved health-seeking behavior and socioeconomic status to prevent VVF.
“Increased awareness and economic independence will encourage more women to seek timely medical care,” she advised.