Monday, July 10, 2017

When Childbirth Harms: Addressing the Prevalence of Obstetric Vesicovaginal Fistulas (VVF) in Northern Nigeria

An obstetric vesicovaginal fistula (VVF) is an injury that is contracted during childbirth due to prolonged, obstructed labour without immediate medical intervention. Vaginal fistulas are undeniably one of the most telling examples of inequitable access to maternal health care and until recently, one of the most hidden and neglected conditions (UNFPA, 2012).

Per the World Health Organization (WHO), it is estimated that over 20 million women are living with this condition. About 50,000 to 100,000 new cases are reported every year. In West Africa, the estimated incidence rate is 3 to 4 cases per 1,000 deliveries (Daru, P., Karshima, J., Mikah, S., & Nyango, D. (2011). In Nigeria alone, it is estimated that almost one million women are awaiting surgical repair. Though this is simple and cost-efficient, lack of funds, resources, and medical staff in rural villages, present a threat to treatment.

Although there are various conservative and noninvasive procedures, surgical correction remains the primary method with a higher success rate than alternative methods. The average cost of treatment is only $300 per patient but economically speaking, it is more cost effective to enact primary preventive programs which will tackle the issue before it gets to the point of surgery.

In Nigeria, the Federal Ministry of Health is putting in place laws to reduce the prevalence of vaginal fistulas. Among these laws are national training on VVF management, expansion of services for treatment, and centers for rehabilitation. A new 350-bed capacity also presents hope. It is equipped with state of the art technology and is staffed with trained physicians. Nigeria is also looking to create a midwifery program to compensate for the country's lack of nurses. These efforts are estimated to reduce maternal mortality by 78% (Dialysis World Nigeria, 2014). 

In order to truly alleviate maternal mortality, increasing access to educational programs should be the first step. Educated women are less likely to die in childbirth. Therefore, hospitals, clinics, schools, and community organizations should incorporate holistic teachings. Vaginal fistulas are absolutely preventable but social inequities, inadequate health systems, poverty, malnutrition, illiteracy, and detrimental traditional practices make them almost unpreventable.

A collaborative effort is also necessary. Traditional leaders, lobbyists, advocates, midwives, physicians and other healthcare personnel should come together to enact a plan for action. When doing this, one must take into consideration cultural, linguistic, and religious differences. With that, VVF can certainly be abolished.

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