NIGER: Botched birth survivors battle fistula

Niger is one of the most dangerous places in the world to give birth.

Thirty women lolling on mats outside a non-governmental organisation (NGO) recovery clinic in Niamey might well wish they had not been so lucky to survive.

They are alive, but, having endured an agonising labour lasting two or three days and finally having had their dead children cut out of them, they have been left with fistula, a tearing of the tissue that develops when blood supply to the tissues of the vagina and bladder and/or rectum is cut off during prolonged obstructed labour.

When the tissue dies a hole forms through which urine and faeces pass uncontrollably.

Fistula is the ultimate symbol of childbirth gone wrong because of poor health care access and the high prevalence of men marrying under-age girls in Niger.

Ostracised

Many of the women here have been ostracised by their families and communities, and even been banned from using public transport because of their smell.

Unaware that their problem can sometimes be fixed with surgery, or their symptoms at least alleviated with something as simple as cotton underwear with plastic and an absorptive sponge sown inside, they have endured months or years hiding in shame.

According to the World Health Organization, two million girls and women around the world live with fistula, almost all of them in developing countries.

The NGO the Fistula Foundation, estimates 100,000 new cases appear every year worldwide, but only 6,500 women are treated annually, due to lack of money and doctors.

In Niger, the operation costs upwards of 1 million CFA francs (US$2,100). There are just four surgeons in the country capable of performing the complicated and highly specialised surgery.

Neglect

The problem is so neglected by Niger’s authorities that no nationwide data exists on the number of women affected there, even though Niger is believed by activists to have one of the highest rates of fistula in the world.

Salamatou Traoré, who in 1998 set up Dimol, which means “dignity” in the local Peulh language, one of the few organisations in Niger which helps girls and women with fistula, estimates that hundreds more women with fistula are living untreated in isolated parts of Niger.

“Fistula is a problem that mostly affects women in rural areas where the women have no access to health services, where ignorance and tradition prevails over common sense,” Traoré said.

At the Dimol recovery centre for women with fistula in Niamey, 60 percent of the girls and women there got their fistula while attempting to give birth too young.

Just letting girls finish school before marrying them off would help avoid the bulk of the early marriage-related fistula cases, Traoré said.

“Even by 16 they are developed enough to give birth if they want to.”

Education

Ninety percent of the 380 women Dimol has treated for fistulas never finished school, and cannot read or write.

Many of the other cases were caused by an obstructed labour which could have been prevented had the woman been given adequate and timely medical attention.

Less than 20 percent of women in Niger will give birth in the presence of a qualified medical official, according to the UN Population Fund (UNFPA).

Some women’s bodies simply collapsed after they gave birth to more than 12 children in their lifetime. The average number of births per mother in Niger is 7.1.

Educating women about their right to choose and the importance of proper healthcare during pregnancy would be another useful step to combating the problem, Traoré said.

But more important for her is educating men. “The problems these girls have were not caused by them - it’s not them who wanted to get married, it’s the men,” she said.

Changing visions

Dimol is also working to give women a more empowered vision of their future: “We’re also trying to make women be instilled with the realisation that they can have a different vision of themselves and to know what they can do to achieve their own goals,” Traoré said.

Many of the young girls at the Dimol centre, some still wearing jewellery and decorative tattoos from their wedding days, will never recover from their fistula ordeal.

Not all fistula cases can be repaired, and the psychological scars from the experience might well last a lifetime.

“After the fight to repair the physical damage more needs to be done to help these women get back into society,” Traoré said. “They have often been beaten, excluded and severely traumatised. Often they cannot go back to their families.”

What the longer-term psychological effects of fistula might be are not known. Dimol lacks the funds to provide any kind of psychotherapy for the women, and Traoré says that this aspect of the organisation’s work is sorely lacking.

“There’s no way we can afford to do it,” she said.