A STUDY ON EARLY MARRIAGE AND ITS IMPACT ON THE HIGH INCIDENCE OF OBSTETRIC FISTULA IN NORTHERN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Obstetric fistula is a serious childbirth-related injury that occurs when an abnormal hole forms between a woman’s vaginal canal and either the urinary tract or rectum. This condition typically results from prolonged, obstructed labor when timely medical assistance is unavailable. Women affected by this condition suffer from uncontrollable leakage of urine or feces, which leads to social rejection and significant emotional trauma (Wall, 2022). The condition is more prevalent in under-resourced areas where access to quality maternal healthcare is limited. This is particularly true in parts of sub-Saharan Africa and South Asia (Tebeu et al., 2022). In Nigeria, the northern region has become a focal point in discussions surrounding obstetric fistula due to its high incidence, which is frequently linked to cultural practices such as early marriage (UNFPA, 2018). Early marriage refers to the union of individuals, where at least one is below 18 years of age, with girls usually being significantly younger than their male partners (UNICEF, 2015). This custom is widespread in Northern Nigeria and is deeply rooted in religious, socio-economic, and cultural beliefs. Families often arrange early marriages for young girls in hopes of securing financial stability or fulfilling social or religious expectations (Cook, Dickens, & Syed, 2015). Although marrying off daughters at a young age is often intended to provide economic security, it inadvertently exposes them to major reproductive health risks—especially in regions where healthcare infrastructure is lacking. In Northern Nigeria, early marriage contributes significantly to the high occurrence of obstetric fistula. Young brides are more likely to become pregnant before their bodies are physically mature, making them prone to complications such as obstructed labor, which is a key cause of fistula (Muleta et al., 2017). The situation is made worse by the socio-economic conditions prevalent in the region—characterized by high poverty levels, limited literacy, and poor access to healthcare. Many of these young girls do not receive the essential prenatal and childbirth care that could have helped prevent prolonged labor and the development of fistula.The health consequences of obstetric fistula are severe. Women often experience continuous incontinence, frequent infections, and sometimes infertility (Bangser, 2016). Beyond the physical toll, the social implications are equally devastating. Women with fistula are often shunned by their communities and families because of the odor and the stigma attached to their condition. This social exclusion frequently results in deep emotional pain, including depression and anxiety (EngenderHealth, 2022). In communities where a woman's value is largely measured by her ability to bear children and fulfill marital roles, those suffering from obstetric fistula face significant marginalization (UNFPA, 2018). The economic impact is also profound. Many women affected by fistula are unable to engage in work due to their physical condition or social isolation. This often leads to dependency on others and increased poverty (Pope, Bangser, & Harris, 2017). In Northern Nigeria—where poverty is already a pressing issue—the presence of obstetric fistula places additional financial stress on families and the broader society. Over the past decade, there have been concerted efforts to address this issue. These include the establishment of centers for surgical repair and the expansion of maternal healthcare services. Organizations like the United Nations Population Fund (UNFPA) have also launched awareness campaigns and medical programs to reduce fistula cases by promoting better maternal health and gender equality (UNFPA, 2018). Despite these initiatives, longstanding cultural practices such as early marriage continue to undermine progress, making the condition persistent in the region. Although legal frameworks exist to prohibit child marriage, the enforcement of these laws remains weak. Cultural traditions often outweigh legal provisions, prioritizing family interests over the physical and emotional well-being of young girls (UNICEF, 2015). Therefore, this study aims to evaluate the role that early marriage plays in the ongoing prevalence of obstetric fistula in Northern Nigeria. 1.2 Statement of the Problem The continued high rates of obstetric fistula in Northern Nigeria represent a major public health challenge, closely tied to the cultural norm of early marriage. Marrying girls before they reach 18 years of age significantly increases the likelihood of early pregnancies, which are often complicated by prolonged or obstructed labor—leading to the development of fistulas (Wall, 2022). These early unions often occur in rural communities where access to maternal healthcare is severely limited, compounding the risks associated with childbirth (Muleta et al., 2017). Cultural and economic factors in the region sustain the practice of early marriage, restricting girls' opportunities for education and economic advancement. This increases their vulnerability to maternal health issues (UNICEF, 2015). While efforts by governments and non-governmental organizations have been made to curb this problem, the persistence of obstetric fistula suggests that current interventions have not sufficiently addressed the root causes. Thus, there is a need for targeted research into how early marriage contributes to the prevalence of this condition in Northern Nigeria. 1.3 Objective of the Study The overall objective of this research is to explore how early marriage contributes to the high incidence of obstetric fistula in Northern Nigeria. The specific aims are to: i. Assess the prevalence of early marriage in Northern Nigeria. ii. Investigate how early marriage contributes to the development of obstetric fistula among young women in the region. iii. Identify the challenges young women face in accessing timely and adequate obstetric care. iv. Recommend strategies to reduce early marriage and its related health complications in Northern Nigeria. 1.4 Research Questions To guide the study, the following research questions are posed: i. What is the prevalence of early marriage in Northern Nigeria? ii. In what ways does early marriage contribute to the development of obstetric fistula among young women in the region? iii. What are the barriers preventing young women from accessing timely obstetric care during labor? iv. What strategies can be implemented to reduce early marriage and its associated health risks in Northern Nigeria? 1.5 Significance of the Study This study will bring to light the serious health risks that young girls in Northern Nigeria face due to early marriage. The findings will be valuable to healthcare professionals and policymakers by highlighting the urgent need to improve maternal healthcare services, especially in underserved rural areas. This improvement is crucial in preventing complications linked to early pregnancies. Moreover, the study will enrich academic literature and provide a useful reference for future researchers who wish to explore similar topics. 1.6 Scope of the Study This research is focused on examining the link between early marriage and the prevalence of obstetric fistula in Northern Nigeria. Specifically, it explores the rate at which early marriage occurs in the region, investigates how it contributes to the incidence of obstetric fistula among young women, identifies the obstacles to accessing quality maternal healthcare, and proposes strategies to mitigate the risks. Geographically, the study is limited to Jigawa State. 1.7 Limitations of the Study As with most research projects, this study encountered a few limitations. Time constraints posed a challenge, as the researcher had to balance this project with academic responsibilities such as attending lectures. Financial limitations were also encountered, especially in covering expenses for printing, typing, sourcing relevant materials, and data collection. Limited availability of literature on the specific topic further posed a difficulty, given that detailed research in this area is relatively scarce. 1.8 Definition of Terms Early Marriage: A formal or informal union where at least one partner is below the age of 18. This practice is commonly linked to increased health, educational, and social risks for girls, especially in low-income settings. Obstetric Fistula: A serious childbirth injury where a hole forms between the vagina and either the bladder or rectum due to prolonged labor without proper medical care. It results in incontinence and carries significant health and social consequences. Maternal Health: Refers to the health of women during pregnancy, childbirth, and the postnatal period, including efforts to prevent and treat maternal complications and mortality. Socio-Cultural Factors: Social norms, customs, beliefs, and traditions that shape behaviors within a community. In this context, they often reinforce early marriage practices. Healthcare Access: The ability of individuals to obtain needed health services, influenced by factors like affordability, availability, and the quality of care—especially during pregnancy and delivery. Prolonged Labor: Labor that lasts more than 20 hours for first-time mothers or more than 14 hours for women who have previously given birth. It increases the risk of complications such as obstetric fistula. Poverty: The lack of financial resources necessary to meet basic needs such as healthcare, education, and shelter. Poverty plays a major role in the persistence of early marriage and poor maternal outcomes. Gender Inequality: Disparities in treatment, rights, and opportunities based on gender. This inequality contributes to the continuation of early marriage and its harmful effects. Reproductive Health: A state of physical, emotional, and social well-being related to the reproductive system. It includes family planning, maternal care, and protection from sexually transmitted infections.