AN EVALUATION OF PUBLIC ATTITUDES AND SOCIAL STIGMA SURROUNDING OBSTETRIC FISTULA IN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Obstetric fistula is a serious medical condition that typically arises when a woman experiences prolonged and obstructed labor without receiving timely medical intervention. This results in the formation of an abnormal opening between the birth canal and the bladder or rectum. The condition causes continuous leakage of urine or feces, which can severely diminish the quality of life for the affected women. It is most commonly found in low-income settings, particularly across sub-Saharan Africa and South Asia, where access to quality maternal healthcare is often limited (Tunçalp et al., 2015). In Nigeria—one of the countries with the highest recorded cases of obstetric fistula—millions of women are believed to be silently suffering from this condition due to the stigma that surrounds it (Wall et al., 2015). The prevalence of the disorder is worsened by the country’s large population and uneven distribution of healthcare services. According to the United Nations Population Fund (UNFPA), around 150,000 Nigerian women are currently living with untreated obstetric fistula, with an estimated 12,000 to 15,000 new cases emerging each year (UNFPA, 2017). The leading cause of obstetric fistula in Nigeria is prolonged obstructed labor, often aggravated by the lack of trained healthcare providers, delayed or unavailable caesarean sections, and poorly equipped healthcare facilities—especially in rural areas (Kimani et al., 2020). Early marriage and teenage pregnancies also play a significant role in the high occurrence of the condition. Girls who marry and become pregnant in adolescence—especially those from poor backgrounds—are at higher risk, as their bodies are often not physically mature enough for childbirth, increasing the likelihood of complications like fistula (Adler et al., 2017). Additionally, cultural practices and gender inequality compound the issue, with many women being denied access to adequate reproductive healthcare or the autonomy to make decisions about their own health (Bangser, 2016). Obstetric fistula is not just a medical condition; it also represents a deeply rooted social issue. Women living with the condition often face social exclusion due to the constant leakage of urine or feces, which causes shame and embarrassment. They are frequently isolated from their communities, abandoned by their partners and families, and denied access to social and economic opportunities. Wall et al. (2015) note that many women with fistula report feelings of deep humiliation and poverty, often being unable to find work or remarry, thereby deepening their vulnerability. The psychological effects of obstetric fistula are also profound. Many women experience depression, hopelessness, and a sense of worthlessness. The stigma they face is worsened by cultural misconceptions that label them as cursed or immoral (Pope et al., 2021). This societal rejection not only strips them of their dignity but also prevents many from seeking the medical help they need, as they fear further discrimination (Ahmed & Holtz, 2017). Despite the Nigerian government’s efforts and the involvement of international organizations, obstetric fistula remains a pressing public health issue. Various national initiatives have been implemented to provide surgical treatment for fistula patients, but the outcomes have been mixed. For example, the UNFPA, working with the Nigerian government, has supported fistula repair centers and launched outreach programs to identify and assist affected women (UNFPA, 2017). However, numerous challenges persist, such as limited healthcare infrastructure, insufficient training for medical staff, and a stark divide in access to healthcare between urban and rural areas (Kimani et al., 2020). Moreover, the process of reintegration after successful surgical repair is often neglected. Many women continue to suffer from social rejection and economic struggles due to the deeply entrenched cultural beliefs surrounding the condition. As Bangser (2016) argues, addressing obstetric fistula requires more than just medical treatment—it demands a comprehensive approach that includes community education, reintegration support, and economic empowerment for affected women. Understanding community attitudes is essential to creating effective interventions, especially given the widespread stigma and the powerful role community beliefs play in either facilitating or hindering access to care. Misconceptions about the cause of fistula—such as beliefs that it is a result of infidelity or divine punishment—contribute to the ongoing stigma (Donnelly et al., 2015). Therefore, this study seeks to explore how community perceptions and associated stigma affect women suffering from obstetric fistula in Nigeria. 1.2 Statement of the Problem Obstetric fistula remains a significant public health issue in Nigeria, particularly in rural and disadvantaged communities. Caused mainly by prolonged and obstructed labor, the condition has both physical and social repercussions for affected women. While efforts have been made to reduce its incidence, many women still endure the devastating consequences—such as constant leakage of urine or feces—which result in shame, social rejection, and isolation (Wall, 2015). Beyond the physical symptoms, women living with fistula are often viewed through a lens of cultural and spiritual judgment. They may be perceived as cursed or unclean, leading to abandonment by their spouses and families, exclusion from community life, and economic hardship (Pope et al., 2021). These stigmas are rooted in cultural and societal misunderstandings that fail to recognize the medical nature of the condition. As a result, many affected women are reluctant to seek medical treatment for fear of further discrimination (Bangser, 2006). Gaining a deeper understanding of how communities perceive obstetric fistula, and the stigma attached to it, is crucial for developing effective, stigma-reducing interventions. This study, therefore, aims to explore these community perceptions and the impact of stigma on the lives of affected women in Nigeria. 1.3 Objective of the Study The main objective of this study is to examine community perceptions and the stigma surrounding obstetric fistula in Nigeria. The specific objectives are: i. To determine the extent of social stigma experienced by women living with obstetric fistula in Nigeria. ii. To explore community members’ views on the cultural beliefs that contribute to the stigma associated with obstetric fistula. iii. To assess how these community perceptions influence women’s willingness to seek medical treatment for obstetric fistula. 1.4 Research Questions The following research questions will guide the study: i. What is the extent of social stigma faced by women suffering from obstetric fistula in Nigeria? ii. How do community members perceive the cultural beliefs that contribute to the stigma surrounding obstetric fistula? iii. In what ways do community perceptions affect the willingness of women to seek medical treatment for obstetric fistula? 1.5 Significance of the Study The findings from this study will be valuable to several stakeholders. For the Ministry of Health and public health practitioners, the results can inform targeted strategies that address both medical care and social barriers to treatment. The study will also guide the development of awareness campaigns that promote early diagnosis, proper treatment, and prevention. For policymakers, the research will provide evidence to support more robust healthcare policies that prioritize maternal health, ensure adequate fistula treatment centers, and promote community education to reduce stigma. Academically, the study will contribute to the existing literature on obstetric fistula and serve as a reference for future researchers interested in maternal health and social stigma in Nigeria 1.6 Scope of the Study This study focuses on how communities in Nigeria perceive obstetric fistula and the stigma associated with it. It will specifically investigate the social stigma experienced by women, community beliefs contributing to the stigma, and how these perceptions affect women’s decisions to seek medical care. Geographically, the study is confined to Kano State. 1.7 Limitations of the Study As with any academic research, this study faced a few limitations: Time Constraints: Balancing this research with other academic responsibilities such as attending lectures posed a challenge for the researcher. Financial Constraints: The research process required substantial financial resources for tasks such as printing, sourcing materials, and conducting fieldwork. Limited Access to Materials: Due to the relatively underexplored nature of the topic, finding relevant literature and information was sometimes difficult. 1.8 Definition of Terms Obstetric Fistula: A health condition resulting from prolonged obstructed labor, where a hole develops between the birth canal and bladder or rectum, causing continuous leakage of urine or feces. Community Perception: The shared beliefs, attitudes, and opinions held by members of a community regarding a particular issue. In this context, it refers to how communities view obstetric fistula and those affected by it. Stigma: A form of social discrimination or negative labeling. In this study, it refers to the shame and exclusion experienced by women with obstetric fistula. Social Reintegration: The process of helping marginalized individuals rejoin society. Here, it pertains to efforts aimed at restoring the social status of women who have undergone fistula treatment. Cultural Beliefs: Shared values and traditions passed down within a society that shape behavior and perspectives. This study focuses on how such beliefs contribute to the stigma of obstetric fistula. Gender Norms: Socially accepted roles and behaviors assigned to men and women. This concept is relevant to understanding how women with obstetric fistula are perceived and treated. Maternal Health: The overall health of women during pregnancy, childbirth, and postpartum. The study explores how improving maternal health services can help prevent conditions like obstetric fistula.