AN INVESTIGATION OF THE CHALLENGES HINDERING WOMEN'S ACCESS TO OBSTETRIC FISTULA TREATMENT IN NORTHERN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Obstetric fistula is a maternal health complication commonly found in some low-income countries, primarily resulting from prolonged obstructed labor. It occurs when an abnormal hole develops between the vagina and either the bladder or the rectum, causing constant leakage of urine or feces. If left untreated, obstetric fistula can lead to long-term social isolation, shame, and discrimination. Although the condition is both preventable and treatable, many women in these regions face numerous obstacles in seeking treatment. These include a lack of awareness about the condition and its treatment, inadequate financial resources, a shortage of qualified fistula surgeons, and long waiting times in hospitals (Adamu & Salihu, 2019). This condition is a severe childbirth injury that leads to continuous, uncontrollable leakage due to an abnormal connection between a woman’s birth canal and her bladder or rectum. The main cause is prolonged obstructed labor without timely medical intervention, especially in places where emergency obstetric care is unavailable. According to the World Health Organization (WHO, 2018), around two million women globally live with untreated obstetric fistula, with 50,000 to 100,000 new cases occurring each year, mostly in sub-Saharan Africa and Asia. Northern Nigeria has a notably high rate of obstetric fistula, largely due to widespread poverty, early marriage, and limited access to quality healthcare. These health challenges are closely tied to cultural and socioeconomic factors that particularly affect women in this region. Early marriage is especially common in Northern Nigeria, often leading to pregnancy before a girl’s pelvis is fully developed, significantly increasing the risk of obstructed labor and, consequently, obstetric fistula (UNICEF, 2017). In addition, many women give birth at home without the assistance of trained medical personnel, further increasing the danger of complications during childbirth (Adamu & Salihu, 2019). The consequences of obstetric fistula are devastating—not only causing serious physical harm but also leading to emotional and social trauma. Affected women may suffer from chronic pain, repeated infections, and infertility. Moreover, the stigma attached to this condition often results in social rejection, marital breakdown, and loss of economic opportunities, which can deepen the cycle of poverty for these women (Wall, 2022). The psychological toll is equally profound, with many women experiencing depression, anxiety, and other mental health issues due to their condition (Ahmed & Holtz, 2017). Despite the fact that obstetric fistula is both avoidable and curable, access to treatment in Northern Nigeria remains extremely limited. The region faces major challenges in healthcare delivery due to weak infrastructure, a shortage of trained medical professionals, and constrained financial resources. Most of the specialized centers that offer fistula repair surgery are located far from rural communities, making them inaccessible for many women who need care (Tebeu et al., 2022). Additionally, many women are unaware that their condition can be treated or are afraid of the social implications of seeking help (Browning, 2020). Efforts to address obstetric fistula in Northern Nigeria have included surgical repairs, community awareness programs, and training for healthcare workers. However, these efforts have not been sufficient to meet the overwhelming need. Therefore, this study aims to explore the barriers that prevent women in Northern Nigeria from accessing treatment for obstetric fistula. 1.2 Statement of the Problem Obstetric fistula remains a serious public health issue in Northern Nigeria, particularly among women who lack access to comprehensive maternal healthcare services. Although various initiatives have been implemented to combat this issue, many women still face significant challenges in getting the medical help they need. These challenges are rooted in socio-cultural beliefs, financial limitations, and inadequate healthcare systems. Cultural beliefs and social stigma play a major role in preventing women from seeking care. In many communities, obstetric fistula is associated with shame, which often leads to social exclusion and discrimination. This stigma discourages affected women from coming forward for treatment (WHO, 2018). Additionally, low levels of education among women in the region hinder their understanding of the condition and their knowledge of available treatment options (Adamu & Salihu, 2019). Economic constraints are another critical barrier. Many women in Northern Nigeria live in poverty and cannot afford the costs associated with surgery or traveling to health centers that provide fistula care (Wall, 2022). The scarcity of specialized health facilities equipped to perform fistula repairs only makes the situation worse, limiting timely and appropriate medical care. Furthermore, the overall healthcare infrastructure in Northern Nigeria is lacking. There are too few trained healthcare providers and limited medical supplies and facilities capable of addressing the issue. These systemic shortcomings make it even more difficult for women to receive the care they need (Tebeu et al., 2022). As a result, many women continue to suffer from this preventable and curable condition, enduring severe physical, psychological, and social consequences. Consequently, this research seeks to investigate the barriers that hinder access to obstetric fistula treatment among women in Northern Nigeria. 1.3 Objective of the Study The primary aim of this study is to explore the barriers that prevent women in Northern Nigeria from accessing treatment for obstetric fistula. The specific objectives are to: i. Identify the socio-cultural factors that delay treatment-seeking for obstetric fistula in Northern Nigeria. ii. Assess the economic challenges that obstruct access to obstetric fistula care in the region. iii. Examine the psychological factors influencing women’s decisions to seek treatment. iv. Recommend effective strategies for improving access to obstetric fistula treatment in Northern Nigeria. 1.4 Research Questions This study is guided by the following research questions: i. What socio-cultural factors contribute to delayed treatment-seeking among women with obstetric fistula in Northern Nigeria? ii. What are the economic barriers that prevent women from accessing obstetric fistula treatment in Northern Nigeria? iii. What psychological obstacles affect women’s decisions to seek care for obstetric fistula? iv. What strategies can be recommended to enhance access to obstetric fistula treatment in Northern Nigeria? 1.5 Significance of the Study This research will be particularly valuable to the Ministry of Health, as it will highlight the key obstacles preventing women from receiving timely and effective treatment for obstetric fistula. The findings can guide the development of targeted healthcare interventions and policies aimed at improving access to care for affected women. By addressing these barriers, the Ministry can help reduce the number of untreated cases and improve overall maternal health outcomes. Moreover, this study will contribute to the academic field by expanding the current body of knowledge on maternal health challenges in low-resource settings. It will also serve as a useful reference for future researchers interested in maternal health, women’s rights, and public health policy. 1.6 Scope of the Study This study focuses on the barriers to accessing treatment for obstetric fistula among women in Northern Nigeria. Empirically, it will examine the socio-cultural, economic, and psychological factors that delay or prevent treatment-seeking and propose strategies for improving access to care. Geographically, the study is confined to Zamfara State. 1.7 Limitations of the Study As with any research effort, this study faced a few limitations. Time constraints: The researcher had to manage this study alongside other academic responsibilities, such as attending lectures and completing other coursework. Financial limitations: Conducting the research involved significant expenses, including printing, typesetting, and gathering relevant literature and data. Availability of materials: There was limited access to literature on the specific subject matter, which posed a challenge in sourcing comprehensive reference materials for the study. 1.8 Definition of Terms Obstetric Fistula: A childbirth-related injury resulting in an abnormal connection between a woman’s birth canal and her bladder or rectum, typically caused by prolonged, obstructed labor without medical intervention. This leads to continuous leakage of urine or feces. Treatment Access: The ability of individuals to receive necessary medical care, including factors like affordability, availability, and social acceptability of healthcare services. Socio-cultural Factors: Social and cultural influences—including beliefs, norms, traditions, and stigma—that affect individuals’ health-seeking behaviors and interactions within their communities. Economic Barriers: Financial difficulties that restrict people from accessing needed services, such as treatment costs, travel expenses, and income loss. Healthcare Infrastructure: The facilities, systems, equipment, and personnel necessary to deliver effective healthcare services. Social Stigma: The negative societal attitudes and discrimination directed toward individuals with a particular condition. In the case of obstetric fistula, stigma often leads to social isolation and discourages women from seeking help.