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The problem of vesico-vagina fistula still remains a ravaging scourge in resourcepoor
countries of which Nigeria is visibly prominent. A majority of the cases are
attributed to prolonged complicated labour due to inaccessibility of adequate and
immediate obstetric health care. Complicated labour arises as a result of narrow
pelvis bones of victims due to suffering from poor nutrition. While the above
factors are noted as the direct cause to the prevalent of VVF, there are other
socio-cultural conditions which predispose victims to this disease. Notable
among them are the following: poverty; marital age; illiteracy; hazardous
traditional practices, such as female circumcision. VVF victims often live an
unworthy life. Many of them have been abandoned or divorced by their husbands
and become ostracised by families and societies because of their repulsive smell
and inability to engage in sexual activity and bear children. VVF victims suffer
both physical and social consequences, many of them find it difficult to engage in
any economic activity, surviving the hardship is very complicated and pathetic;
some victims turn to street begging, while others survive through hawking of
“bagged” water and selling firewood.
Most studies conducted on the problem of Vesico vaginal fistula are done from
the medical perspectives, often neglecting the psycho-social consequences
faced by the sufferers. This study, however, discusses the socio-cultural and the
psychological consequences of the disease. Locally and internationally, attempts
are being made to eradicate the problem of VVF, however, if the Nigerian
government does not recognise the incidence of VVF as a major public health
issue, it will continue to ravage lives of Nigerian women, hence increasing
maternal mortality in the country. This study proffers recommendations to help
eradicate or alleviate the problem in Nigeria.
CHAPTER 1.0 INTRODUCTION
“In Vast areas of the world, in South East Asia, in Burma, in India, in parts of central America,
South America and Africa 50 million women will bring forth their children this year in sorrow, as in
ancient Biblical times, and exposed to grave dangers. In Consequence, today as ever in the past,
uncounted hundreds of thousand of young mothers annually suffer childbirth injuries; injuries
which reduce them to the ultimate state of human wretchedness.
Consider these young women. Belonging generally to the age group of 15-23 yrs, and thus at the
very beginning of their reproductive lives, they are more to be pitied even than the blind, for the
blind can sometimes work and marry. Their desolation descends below that of the lepers, who
though scarred, crippled and shunned, may still marry and find useful work to do. The blind, the
crippled and the lepers with lesions obvious to the eye and therefore appealing to the heart, are
all remembered and cared for by great charitable bodies, national and international.
Constantly in pain, incontinent of urine or faeces, bearing a heavy burden of sadness in
discovering their child stillborn, ashamed of a rank personal offensiveness, abandoned therefore
by their husbands, outcasts of society, unemployable except in the fields, they live, they exist,
without friends and without hope.
Because their injuries are pudenda, affecting those parts of the body which must be hidden from
the view and which a woman may not in modesty easily speak, they endure their injuries in silent
shame. No charitable organisations become aware of them. Their misery is utter, lonely and
RHJ Hamlin and E Catherine Nicholson
(Hamlin & Nicholson 1966)
The above quote gives a good grasp on the understanding of the miserable and
gloomy life of young girls who are victims of VVF, a gynaecological condition
which results from childbirth difficulties. The story illustrates the condition of
women who go about during the day with big smelly and tattered clothes in
between the upper cleavages of their legs. At night they go to sleep, albeit
sleeplessness, and wake up in the morning in the middle of wet and stinky
beddings. Getting up from the bed becomes so embarrassing and humiliating.
Theirs is a story of young girls whose first child was born still, and who may
never have the opportunity of getting married or having babies again. Thiers is a
condition that is avoided in the public discussion because of the high level of
stigma attached to it. Coping with this condition is done in isolation and
It should be noted; however, that medical repair and treatment of fistula is
possible. Whether treated or untreated, its effect on the psychological well-being
of the victims can not be over emphasised.
In most societies of the third world, women are often seen as a vulnerable
gender group, however, the attendant devastating and humiliating effects of ill
health, e.g. VVF further make them more vulnerable in these societies, thus
exposing their emotional instability. These women often see themselves as being
different from other women in several areas, in spite of the fact that their sexual
freedom has already been curtailed, they find it difficult to enjoy their sexuality;
other infectious diseases may also arise; and they age more easily and quickly
than their contemporaries who have not had their womanhood curtailed. This
disrepairable and demoralizing condition thus destroys the psychological wellbeing
of the victims. When someone loses confidence in enjoying a quality life,
she often lives a miserable life throughout her life. This condition is typical of a
Nigerian woman who is a victim of VVF.
The term “vesico” according to the medical profession is called urinary bladder.
Vesico-vaginal fistula is thus the abnormal connection between the urinary tract
and the vagina such that there is an uncontrollable leakage of urine into the
vaginal tract. According to Villey VJ (2006), “VVF is an abnormal communication
between the urinary bladder and the vagina that results in the continuous
involuntary discharge of urine into the vaginal vault”.
Several literatures reveal that the condition has many causes with variation
depending on the social and educational status of people. Undoubtedly, women
from low and poor social and educational status are more often than not ravaged.
Kabir et al (2003) observed the following to be possible causes of VVF:
prolonged obstructed labour, trauma during operative delivery, infections and
irradiation necrosis from treatment of cervical carcinoma. According to Villey,
numerous factors contribute to the development of VVF in developing countries,
among other cultures, which promotes marriage and conception at a young age,
often before full pelvic growth has been reached.
Thus, an early child-bearing stage, poor physical growth and health of the mother
coupled with poor medical facilities are all contributing to the prevalence of
obstructed labour, hence VVF condition among women in low socio-economic
status of Nigeria.
In spite of the medical consequences (diagnosis, treatment and so on) accorded
the victims of VVF, the psycho-social consequences seem as more unbearable.
In most Nigerian communities, affected women are ostracized from their local
community, divorced, abandoned and remain childless. Since the urinary is
uncontrollable, the affected women always remain wet and smelly, leading to
discomfort and humiliation from people around. According to Sadik (2001),
victims of VVF “often work alone, eat alone, and are not allowed to cook for
anyone. They sleep in separate huts and often end up on the streets, begging for
The discrediting effect VVF is a stigma and this is a brutal punch to the
psychological well-being of its victims. A stigmatized individual does not live a
successful and happy life; this is the case of a woman living with VVF!
Overlooking the vast psycho-social consequences of VVF on its victims is not so
easy to achieve unless social researchers observe her in her own social setting,
thus World Health Organisation (2006) reports “the proper care of fistula victims
requires a holistic approach that pays as much attention to healing the psychosocial
wounds inflicted on these women as it does to curing their physical
Against the background of the preceding exposition, the aim of my thesis is to
unravel the several factors responsible for the incidence of VVF and to look into
the impact of this disease on the psychological well-being of its victims in Nigeria.
With this, I intend to create an understanding and awareness of the socio-cultural
consequences of the VVF condition among its victims in Nigeria.
1.3 RESEARCH QUESTIONS
The following shall constitute the foci of my study:
- What are those factors responsible for the incidence of VVF in Nigeria?
- What are the psycho-social conditions faced by the victims of VVF?
- What are the coping and survival strategies of victims living with VVF?
1.4 CHOICE AND MOTIVATION FOR THE STUDY
This study represents a part of my overall knowledge in the programme leading
to a Master in Health and Society. And the purpose is to demonstrate my
knowledge and a good understanding of the interaction between health and its
While DJP Barker’s research work on “Mothers, Babies and health in Later Life”
places emphasises on the importance of good health care delivery to women at
both pre and post natal stage as being imperative in preventing some of the
human diseases, such as coronary heart diseases and so on in later life (Barker,
1998:136), my own study, though not primarily about preventing diseases among
women, focuses on the impact of diseases on the quality of life of women, vis a
vis their psychological stability. Thus, my research interest lies in the quality of life
of the vulnerable gender group in Nigerian society, i.e., the women whose
diseased condition has both medical and psycho-social consequences.
VVF victims have traditionally been neglected in reproductive health. The victims
are not getting the attention of programmes, research and donors, often in the
context of interventions to reduce maternal mortality and disability. Sadik (2001)
comments that “so much remains to be done for woman’s health …the frustration
is that the area of maternal mortality and morbidity is a subject about which we
know in the clinical sense, but so little in the social and cultural sense.”
In a lot of literature on the prevalence of VVF, it becomes so obvious that the
explanation and understanding of the phenomenon focus primarily on the
epidemiological (quantitative) perspective; figures and data are mostly used to
explain the prevalence. Maternal mortality and reproductive health are thus
considered and diagnosed quantitatively. The focus on VVF is mostly on its
medical consequences; hence, its social consequences on the victims are
neglected. Against this background, my own interest lies on the psycho-social
consequences of VVF on its victims.
Since the subject usually stems from the perspective of the so-called “objective”
and hegemonic physicians, the voice and the “real” pains of the victims are
unheard, and when heard, they are usually underestimated with figures.
My choice of research is thus to have a qualitative and phenomenological view of
the patients as they present their everyday life.
This present investigation is motivated and justified in terms of the following:
There is an interest in victims of vesico vagina fistula which places them
more and more in the focus of attention. Due to the dearth of research that
principally explores the impact of the disease on the psychological wellbeing
of its victims, this study is seen as an attempt to respond to this
Most of the research studies concerning vesico vagina fistula have been
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