AN ASSESSMENT OF COMMUNITY PERCEPTIONS AND STIGMA ASSOCIATED WITH OBSTETRIC FISTULA IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

An obstetric fistula is a severe medical disorder that basically occurs when labour is protracted and blocked without prompt medical care, resulting in a hole between the birth canal and the bladder or rectum. This disorder results in persistent urine or faecal incontinence, significantly impacting the quality of life for women who are afflicted. Obstetric fistula is more prevalent in low-resource regions worldwide, particularly in sub-Saharan Africa and South Asia, where access to healthcare is restricted (Tunçalp et al., 2015). It is believed that millions of women in Nigeria, one of the nations with the highest incidence of obstetric fistula, suffer from this ailment, frequently in silence owing to the social shame associated with it (Wall et al., 2015). Nigeria, characterised by its substantial population and extensive healthcare inequalities, has a substantial incidence of obstetric fistula cases. The United Nations Population Fund (UNFPA) estimates that 150,000 women in Nigeria are now living with untreated obstetric fistula, and an additional 12,000 to 15,000 new cases are reported annually (UNFPA, 2017). Prolonged obstructed labour is the main factor contributing to obstetric fistula in Nigeria. This is typically worsened by the limited availability of experienced birth attendants, delayed caesarean sections, and inadequate health facilities, especially in rural regions (Kimani et al., 2020). Child marriage and adolescent pregnancy are major risk factors that contribute to the high prevalence of obstetric fistula in Nigeria. Adolescent females, particularly those from economically disadvantaged households, have a greater propensity to encounter impaired childbirth as a consequence of undeveloped pelvic tissues, thereby increasing the probability of fistula development (Adler et al., 2017). Moreover, the situation is exacerbated by cultural norms and gender disparities, as women are often deprived of sufficient healthcare resources or autonomous authority in making decisions about their reproductive health (Bangser, 2016). Obstetric fistula is not just a medical ailment but also a societal issue that fundamentally impacts the lives of women. The persistent excretion of urine or faeces classifies these women as social outcasts within their cultures. Women in this group often face severe social disapproval, which includes being isolated, rejected by their spouses and families, and excluded from community services. According to Wall et al. (2015), several women afflicted with fistula have feelings of humiliation and impoverishment, often prevented from engaging in employment or entering into new marriages, therefore exacerbating their social and economic susceptibility. Many women experience profound psychological distress as a result of obstetric fistula, including feelings of worthlessness, melancholy, and hopelessness. The mental distress is exacerbated by social ostracism, as women who are afflicted are often seen as cursed or sexually corrupt (Pope et al., 2021). The ailment not only erodes the dignity of women but also presents a substantial obstacle to obtaining treatment, since the negative perception associated with the disorder inhibits many women from seeking assistance (Ahmed & Holtz, 2017). Despite the concerted efforts of the Nigerian government and foreign organisations to tackle the problem, obstetric fistula continues to be a significant public health concern. Systematic initiatives targeting the provision of surgical repair services have been established nationwide, with varying levels of effectiveness. For example, the United Nations Food and Personal Care Agency (UNFPA), in collaboration with the Nigerian government, has been providing assistance to fistula repair facilities and implementing outreach initiatives to detect and provide medical care to injured women (UNFPA, 2017). Nevertheless, there are still notable obstacles that remain, such as restricted healthcare resources, insufficient training for healthcare practitioners, and the stark disparity in healthcare access between rural and urban areas (Kimani et al., 2020).

Furthermore, the matter of restorative integration after restoration is often overlooked. Social stigmatisation and economic hardship persist among many women who have had successful fistula surgery, mostly because of the deeply ingrained cultural beliefs around the illness. Bangser (2016) argues that effectively tackling the negative perception around obstetric fistula requires not just medical intervention but also a holistic strategy including community education, social reintegration programs, and economic empowerment efforts for women impacted by the condition. The assessment of community attitudes is crucial in order to guide successful treatments, considering the widespread stigma and the significant impact that community views have on either enabling or impeding access to care. Obstructive fistula is commonly stigmatised due to misconceptions regarding the ailment, leading many to mistakenly believe it is caused by adultery or divine retribution (Donnelly et al., 2015).  Therefore, the researcher sought to assess community perceptions and stigma associated with obstetric fistula in Nigeria

Statement of the problem

The prevalence of obstetric fistula continues to pose a substantial public health concern in Nigeria, especially in rural and underprivileged areas. This disorder, often caused by extended and disrupted childbirth, results in a physical and social impairment for women who are afflicted. Although attempts have been made to decrease its occurrence, a significant number of women still experience the severe repercussions of obstetric fistula, such as the leaking of urine or faeces, which results in societal stigmatisation and isolation (Wall, 2015). The negative perception linked to obstetric fistula adds added complexity to the process of reintegrating these women into their own societies. Individuals who are affected are often seen as cursed or impure, resulting in their desertion by spousal and familial relationships, social isolation, and financial difficulties (Pope et al., 2021). It is the cultural and societal ideas that fail to acknowledge the medical origins of the disease that give rise to this social stigma. Consequently, a significant number of women refrain from obtaining medical care because they are afraid of being discriminated against or socially excluded, thereby continuing the cycle of distress (Bangser, 2006). Gaining insight into community attitudes and confronting the negative associations related to obstetric fistula is crucial for developing successful therapies.  Hence, the need to assess community perceptions and stigma associated with obstetric fistula in Nigeria. 

1.3 Objective of the study

The broad objective of the study is to assess community perceptions and stigma associated with obstetric fistula in Nigeria. The specific objectives is as follows

Assess the extent of social stigma faced by women suffering from obstetric fistula in Nigeria

Identify the perception of community members on the cultural beliefs that contribute to the stigma associated with obstetric fistula in Nigeria

Investigate how community perceptions affect the willingness of women to seek medical treatment for obstetric fistula

1.4 Research questions

The following questions have been prepared to guide the study

What is the extent of social stigma faced by women suffering from obstetric fistula in Nigeria?

What is the perception of community members on the cultural beliefs that contribute to the stigma associated with obstetric fistula in Nigeria?

How does community perceptions affect the willingness of women to seek medical treatment for obstetric fistula?

1.5 Significance of the study

Findings of the study will be significant to the ministry of health as it will help public health practitioners develop targeted interventions that address both medical treatment and the social barriers to care. It will also provide valuable insights into how to better design awareness campaigns to encourage early diagnosis, treatment, and prevention. Furthermore, the study will be significant to policymakers as it can be used to advocate for stronger healthcare policies that prioritize maternal health services, ensure the availability of fistula repair centers, and foster community education programs to reduce stigma. In addition, the study will be significant to the academic community as it will contribute to the existing body of knowledge and also serve as a guide to future researchers.

1.6 Scope of the study

The study focus on community perceptions and stigma associated with obstetric fistula in Nigeria. Empirically, the study will assess the extent of social stigma faced by women suffering from obstetric fistula in Nigeria, identify the perception of community members on the cultural beliefs that contribute to the stigma associated with obstetric fistula in Nigeria and investigate how community perceptions affect the willingness of women to seek medical treatment for obstetric fistula.

Geographically, the study will be delimited to Tofa LGA, Kano State.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraints are: 

Time: The researcher encountered time constraint as the researcher had to carry out this research alongside other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study

1.8 Definition of terms

Obstetric Fistula: A medical condition caused by prolonged, obstructed labor without timely medical intervention, resulting in a hole between the birth canal and bladder or rectum, leading to continuous urinary or fecal incontinence .

Community Perception: The collective attitudes, beliefs, and opinions held by members of a community about a particular issue or condition. In this study, it refers to how communities view and understand obstetric fistula and those affected by it.

Stigma: A negative social label or discrimination against an individual or group, often resulting from a condition that is seen as shameful or undesirable. In the context of this study, it refers to the negative social judgment of women suffering from obstetric fistula .

Social Reintegration: The process of helping individuals who have been socially excluded or marginalized to regain their place in society. In this study, it refers to the efforts made to help women with obstetric fistula return to normal community life after treatment .

Cultural Beliefs: The shared values, norms, and practices that are passed down within a community or society, influencing behavior and attitudes. This study focuses on how cultural beliefs influence the perception of obstetric fistula in Nigeria.

Gender Norms: Socially constructed roles, behaviors, and expectations that a society considers appropriate for men and women. This term is used in the study to understand how gender roles affect the treatment and perception of women with obstetric fistula.

Maternal Health: The health of women during pregnancy, childbirth, and the postpartum period. This study looks at how maternal health services can help prevent obstetric fistula and reduce its prevalence.

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