AN INVESTIGATION OF THE SOCIOECONOMIC EFFECTS OF OBSTETRIC FISTULA AMONG WOMEN IN NORTHERN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Obstetric fistula is a devastating yet preventable maternal health condition that involves an abnormal opening between the birth canal and the bladder or rectum. This condition typically arises from prolonged, obstructed labour when timely and adequate medical intervention is unavailable. It is especially common in under-resourced settings where access to quality maternal healthcare is limited. Globally, an estimated 2 to 3 million women are currently living with untreated obstetric fistulas, with a significant concentration in sub-Saharan Africa, particularly Nigeria (Fistula Foundation, 2021). In Northern Nigeria, the condition presents a pressing public health challenge, exacerbated by cultural practices, pervasive poverty, and inadequate healthcare infrastructure. According to Bashah et al. (2022), Nigeria sees as many as 2,000 new cases each year, with the highest prevalence found in the northern regions. Factors such as poor antenatal and postnatal care, scarcity of skilled birth attendants, and early marriage significantly contribute to the rising incidence of the condition. Moreover, in many communities, the preference for traditional birth attendants over medically trained personnel increases the risk of obstructed labour, which often leads to the development of fistulas (Kassebaum et al., 2016). Persistent poverty also plays a critical role, limiting women's access to essential maternal health services, including emergency obstetric care that could prevent such complications. The impact of obstetric fistula extends well beyond the physical. Women who suffer from this condition often endure immense physical and emotional trauma. Many are subjected to social ostracism and isolation due to the continuous leakage of urine or feces, which renders them stigmatized and excluded from community life (Aldoh et al., 2021). The physical limitations associated with fistula prevent affected women from engaging in work or economic activities, resulting in financial dependence on family members and a decline in household income (Mason et al., 2016). In communities where women play a crucial role in economic survival, this loss of productivity significantly affects not only individual households but also broader community wellbeing. Beyond economic implications, obstetric fistula severely impacts mental health. Many women experience depression, anxiety, and a deep sense of worthlessness due to social exclusion and the burden of chronic health issues like persistent discomfort, incontinence, and repeated infections (Akinwunmi et al., 2021). Despite the severity of the condition, there remains a significant lack of awareness about obstetric fistula among both healthcare providers and the general public in Northern Nigeria. Many women do not understand the nature of their condition, available treatment options, or the importance of seeking timely medical care (Afolabi et al., 2020). Cultural beliefs and traditional practices related to childbirth further hinder access to appropriate medical interventions. Although some organizations in Nigeria have launched initiatives aimed at preventing and treating obstetric fistula, there remains a considerable knowledge gap, particularly concerning the socioeconomic effects of the condition on women in Northern Nigeria. Therefore, this study aims to explore and analyze the broader socioeconomic impact of obstetric fistula on affected women in this region. 1.2 Statement of the Problem Obstetric fistula is a life-altering condition that disproportionately affects women in developing regions, particularly in Northern Nigeria, where its prevalence remains alarmingly high due to various interrelated socio-economic and cultural factors. Most often resulting from prolonged and obstructed labour without timely medical intervention, the condition causes severe physical damage and brings about significant emotional and social challenges for affected women. Despite the availability of surgical procedures that can repair the fistula, many women remain untreated due to limited access to healthcare services, societal stigma, and widespread poverty (Wall, 2006). The ramifications of this condition are not limited to the individual but ripple outward to affect families and entire communities. Women living with obstetric fistula are frequently marginalized, losing social status and becoming economically vulnerable. They are often unable to engage in work or community activities, leading to a sharp decline in income and increased dependence on family members (Mason et al., 2016). Furthermore, the prevalence of early marriage and low educational attainment among women in this region increases their susceptibility to obstetric complications, thereby reinforcing existing cycles of poverty and social exclusion (Doherty et al., 2014). While numerous studies have explored the medical aspects of obstetric fistula, there is a noticeable gap in research that thoroughly examines its socioeconomic implications. As such, this study seeks to address this gap by investigating how obstetric fistula impacts the socioeconomic status and quality of life of women in Northern Nigeria. 1.3 Objectives of the Study The main objective of this study is to examine the socioeconomic impact of obstetric fistula on women in Northern Nigeria. The specific objectives are: i. To determine the prevalence of obstetric fistula among women in Northern Nigeria. ii. To identify the major causes of obstetric fistula in the region. iii. To investigate the socioeconomic consequences of the condition on affected women. iv. To suggest strategies for enhancing maternal health services in Northern Nigeria. 1.4 Research Questions To guide this study, the following research questions have been formulated: i. What is the prevalence of obstetric fistula among women in Northern Nigeria? ii. What are the main causes of obstetric fistula in this region? iii. What are the socioeconomic impacts of obstetric fistula on women in Northern Nigeria? iv. What strategies can be implemented to improve maternal healthcare services in Northern Nigeria? 1.5 Significance of the Study The findings from this study will be valuable to various stakeholders, particularly the Ministry of Health. By shedding light on the broader impacts of obstetric fistula—not only in terms of physical health but also economic stability and social inclusion—this research will provide a foundation for the design of more effective maternal health policies and intervention programs. Healthcare professionals and policymakers will benefit from insights that can help shape improved service delivery and outreach efforts. Additionally, this study holds academic importance as it adds to the existing literature on maternal health and women’s well-being. It will also serve as a useful resource for future researchers interested in the intersection of gender, health, and socioeconomic development. 1.6 Scope of the Study This study focuses on the socioeconomic consequences of obstetric fistula on women in Northern Nigeria. Specifically, it investigates the prevalence and causes of obstetric fistula, examines its economic and social impacts, and proposes actionable recommendations for improving maternal healthcare in the region. Geographically, the study is restricted to Gagarawa Local Government Area in Jigawa State. 1.7 Limitations of the Study As with any academic research, this study faced certain limitations. One of the key constraints was time, as the researcher had to balance data collection and analysis with other academic responsibilities, including lectures and assignments. Another significant limitation was financial, as the researcher had to cover costs related to printing, typesetting, sourcing relevant literature, and gathering data. Lastly, the availability of research materials posed a challenge. Due to the specialized nature of the topic, there was a limited pool of existing literature, which made the review process more demanding. 1.8 Definition of Terms Obstetric Fistula: A childbirth injury that results in an abnormal opening between the vaginal canal and the bladder or rectum, usually caused by prolonged obstructed labour without timely medical intervention. Socioeconomic Impact: The combined social and economic effects a condition or event has on individuals and communities. Early Marriage: The practice of marrying individuals, particularly girls, before the age of 18. In Northern Nigeria, this is a known contributing factor to obstetric complications due to underdeveloped bodies. Maternal Health: Refers to the health of women during pregnancy, childbirth, and the postpartum period. It includes both physical and mental well-being. Stigma: A form of social disapproval that leads to discrimination or exclusion, often based on a particular health condition such as obstetric fistula. Access to Healthcare: The ability of individuals to obtain essential medical services, including skilled birth attendance, surgical treatment, and follow-up care. In this study, it pertains specifically to the healthcare situation in Northern Nigeria.