AN EVALUATION ON THE IMPACT OF EDUCATION IN MITIGATING THE PREVALENCE OF OBSTETRIC FISTULA IN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Obstetric fistula remains a critical childbirth-related injury affecting countless women worldwide, with a pronounced impact in low-income countries like Nigeria. This condition arises predominantly from prolonged, obstructed labour, leading to a rupture between the vaginal canal and either the bladder or rectum, resulting in uncontrollable leakage of urine or faeces (World Health Organisation [WHO], 2018). Beyond the physical distress it causes, obstetric fistula often subjects affected women to social exclusion, emotional trauma, and financial hardship, all of which are intensified by the stigma attached to the condition (Tunçalp et al., 2015). Despite ongoing international efforts to eliminate obstetric fistula, Nigeria remains heavily burdened, accounting for roughly 40% of the global cases (United Nations Population Fund [UNFPA], 2020). The primary cause continues to be obstructed labour that lasts for days without adequate medical intervention—especially in areas where emergency obstetric services are scarce. The prevalence of early marriages and teenage pregnancies, particularly in parts of Northern Nigeria, further raises the risk due to underdeveloped pelvic structures (Bangser, 2019). The situation is worsened by cultural norms that promote early childbearing, compounded by poverty and inadequate access to healthcare services. Studies show that women in rural and impoverished communities face the highest rates of obstetric fistula due to their limited access to trained healthcare providers and proper maternal care facilities (Wall, 2017). Educational attainment plays a pivotal role in improving women’s health outcomes, especially in preventing obstetric fistula. Educated women are more likely to delay marriage and childbirth, seek prenatal care, and deliver in medical facilities under the care of skilled health professionals (Bangser, 2019). Conversely, lack of education often correlates with early marriage and teenage pregnancies, significantly increasing the risk of obstructed labour. Education also enhances women's ability to make informed decisions about their reproductive health and empowers them to demand quality healthcare. In Nigeria, especially in the northern regions, the persistence of educational disparities among women has been identified as a major contributor to the continued existence of obstetric fistula (Bello et al., 2021). Each year, Nigeria records approximately 13,000 new cases, with an estimated 200,000 women currently living with the condition (UNFPA, 2020) Rural areas bear the brunt of this burden, where poverty, poor healthcare infrastructure, and harmful cultural practices such as early marriage are prevalent. Data from the Nigerian Demographic and Health Survey (NDHS, 2018) confirms that obstetric fistula is most widespread in Northern Nigeria—where educational levels for women are lowest and early marriage is most common. Despite interventions by the government and international organizations—such as the establishment of repair centres and awareness campaigns—numerous challenges remain. A lack of awareness among women about the condition and its causes often delays treatment. Furthermore, the stigma surrounding the condition leads to social withdrawal, making it even harder to identify and assist affected individuals (Wall, 2017). These realities underscore the researcher’s interest in examining how education can play a vital role in reducing the occurrence of obstetric fistula in Nigeria. 1.2 Statement of the Problem Obstetric fistula, although preventable, remains a devastating public health concern in Nigeria, particularly affecting women in rural and underserved communities. It is a medical complication where an abnormal connection develops between the vagina and the bladder or rectum, typically caused by prolonged and obstructed labour without timely medical intervention (WHO, 2018). Even with Nigeria's progress in the health sector, the country still has one of the highest global rates of obstetric fistula, with about 13,000 new cases reported annually (UNFPA, 2020). These figures point to underlying issues such as inadequate maternal health services, early marriages, and low levels of female education. Education is widely acknowledged as a key factor in reducing the risk of obstetric fistula. Studies show that women with better education are more likely to delay marriage and childbirth, seek medical help early, and make informed reproductive health choices (Bangser, 2019). Unfortunately, many women in Nigeria—especially those in rural regions—lack access to quality education, which increases their vulnerability to obstetric complications. The link between education and access to healthcare services highlights the urgent need to address educational inequality as a strategy to curb the high incidence of obstetric fistula. Hence, this study aims to explore how education can contribute to reducing the occurrence of obstetric fistula in Nigeria. 1.3 Objective of the Study The main objective of this study is to explore how education can help reduce the incidence of obstetric fistula in Nigeria. The specific objectives include: i. To examine the prevalence of obstetric fistula among women in Nigeria. ii. To identify the educational-related risk factors associated with obstetric fistula. iii. To evaluate how education contributes to lowering the incidence of obstetric fistula in Nigeria. iv. To propose strategies for incorporating reproductive health education to help prevent obstetric fistula among Nigerian women. 1.4 Research Questions This study seeks to answer the following questions: i. What is the prevalence of obstetric fistula among women in Nigeria? ii. What are the risk factors linked to obstetric fistula in relation to women’s educational status? iii. In what ways does education contribute to reducing the incidence of obstetric fistula in Nigeria? iv. What strategies can be used to integrate reproductive health education in reducing obstetric fistula among Nigerian women? 1.5 Significance of the Study The findings from this research will be valuable to policymakers, helping them advocate for improved maternal healthcare services, the establishment of more fistula treatment centres, and the promotion of community education programs aimed at reducing stigma. Furthermore, the study will enrich the academic community by expanding the existing body of knowledge and serving as a useful reference for future researchers interested in maternal health and women’s education. 1.6 Scope of the Study This research focuses on the role that education plays in mitigating the incidence of obstetric fistula in Nigeria. Specifically, it will investigate the prevalence of obstetric fistula among Nigerian women, examine educational factors contributing to its occurrence, assess the preventive role of education, and suggest reproductive health education strategies that can help address the issue. Geographically, the study is limited to Demsa Local Government Area in Adamawa State. 1.7 Limitations of the Study As with any research undertaking, a few challenges were encountered during this study. These include: Time constraints: Balancing academic responsibilities, such as attending lectures and fulfilling coursework, limited the amount of time available for this research Financial limitations: Conducting the study incurred costs related to printing, sourcing relevant literature, and collecting data. Limited access to materials: Due to the specificity of the topic, finding sufficient and up-to-date literature posed a challenge. 1.8 Definition of Terms Obstetric Fistula: A serious medical condition caused by prolonged or obstructed labour, leading to an abnormal opening between the vagina and bladder or rectum, which results in involuntary leakage of urine or faeces (WHO). Incidence: The number of new cases of a particular disease within a specific time frame, typically presented as a rate per population (CDC). Prevalence: The total number of existing cases of a disease in a population at a particular point in time. Education: A formal process through which individuals acquire knowledge, skills, and critical thinking, usually within institutional settings like schools. Early Marriage: The practice of marrying individuals, particularly girls, before the age of 18, which increases the risk of adverse health outcomes, including obstetric fistula (UNFPA). Health-Seeking Behavior: The various steps individuals take to preserve or improve their health, including visiting health facilities, seeking professional care, or using preventive services.