AN INVESTIGATION INTO THE BARRIERS TO ACCESSING TREATMENT FOR OBSTETRIC FISTULA IN AMONG WOMEN IN NORTHERN NIGERIA

 CHAPTER ONE

INTRODUCTION

Background of the study

Obstetric fistula is a maternal morbidity disease that arises in some low-income nations due to protracted obstructed labour. It causes a puncture between the vagina and the bladder or rectum, through which urine or faeces exit. Failure to cure a fistula may result in enduring social exclusion, judgement, and humiliation. Although obstetric fistula can be prevented and treated, women in these countries face delays in seeking repair due to several reasons such as limited knowledge of their condition and the availability of treatment, insufficient resources for seeking care, scarcity of qualified fistula surgeons, and extended hospital waiting periods(Adamu & Salihu, 2019). An obstetric fistula is a serious injury after delivery characterised by an irregular opening between a woman's birth canal and her bladder or rectum, causing persistent and unmanageable urinary or faecal leaking. The main aetiology of this illness is prolonged, blocked labour without prompt medical intervention, often in environments where emergency obstetric care is not available. An estimated two million women worldwide are living with untreated obstetric fistula, with an annual incidence of 50,000 to 100,000 new cases, mostly in sub-Saharan Africa and Asia, according to the World Health Organisation (WHO, 2018).

The prevalence of obstetric fistula in Northern Nigeria is substantial, mostly attributed to the region's elevated poverty levels, early marriage, and restricted availability of healthcare facilities. The medical problem is intricately connected to socio-economic and cultural elements that have a greater impact on women in this region of the nation. For example, early marriage is a widespread custom in Northern Nigeria, often resulting in pregnancies occurring before the proper development of a young girl's pelvis. This raises the likelihood of obstructed labour and, as a result, obstetric fistula (UNICEF, 2017). Moreover, the cultural tradition of giving birth at home without trained birth attendants increases the risk even more, as any problems that arise during labour may not be rapidly dealt with (Adamu & Salihu, 2019). The ramifications of obstetric fistula are catastrophic, including not just physical damage but also social and psychological distress. Women afflicted with this disorder often endure intense physical pain, persistent infections, and infertility. Furthermore, the societal disapproval linked to obstetric fistula may result in social seclusion, marital dissolution, and a deprivation of financial prospects, therefore reinforcing women in a downward spiral of poverty (Wall, 2022). The psychological repercussions are as significant, since many women experience despair, anxiety, and other mental health disorders due to their illness (Ahmed & Holtz, 2017). Notwithstanding its preventability and treatability, the availability of obstetric fistula therapy in Northern Nigeria is still restricted. The area is confronted with substantial obstacles in delivering sufficient healthcare services as a result of infrastructure shortcomings, a scarcity of skilled healthcare practitioners, and restricted financial resources. Due to their remote location, the limited number of specialised facilities that provide fistula repair surgery are generally inaccessible to the majority of afflicted women residing in rural regions (Tebeu et al., 2022). In addition, a significant number of women lack knowledge about the treatability of their disease or face apprehension about potential social consequences if they seek assistance (Browning, 2020).  The initiatives aimed at tackling obstetric fistula in Northern Nigeria have included surgical intervention, community education campaigns, and healthcare professional training. Nevertheless, these measures have been inadequate in satisfying the need. Therefore, the researcher sought to  investigate the barriers to accessing treatment for obstetric fistula in among women in Northern Nigeria.

1.2 Statement of the problem

Obstetric fistula continues to be a consequential public health concern in Northern Nigeria, mainly impacting women who do not have sufficient access to comprehensive maternal healthcare services. Despite concerted attempts to tackle the issue, a significant number of women in this area encounter considerable obstacles when it comes to entering therapy. The impediments include socio-cultural elements, economic limitations, and insufficient healthcare infrastructure. Various socio-cultural obstacles, including stigma and limited knowledge, significantly hinder women from obtaining therapy. Obstructive fistula is often linked to feelings of shame in certain cultures, resulting in social isolation and prejudice. This, in turn, further deters women who are afflicted from seeking medical treatment (WHO, 2018). Moreover, the limited educational attainment of women in Northern Nigeria hampers their comprehension of the disease and the therapeutic alternatives at their disposal (Adamu & Salihu, 2019). Furthermore, economic obstacles greatly impede the ability to get therapy. Numerous women residing in Northern Nigeria experience poverty and lack the financial means to cover the expenses associated with surgical procedures or travelling to healthcare institutions that provide treatment (Wall, 2022). Insufficient availability of specialised facilities capable of performing fistula repair worsens this problem, therefore impeding women's access to prompt and suitable medical attention. Moreover, the healthcare infrastructure in Northern Nigeria is often insufficient, characterised by a dearth of adequately educated healthcare practitioners and a deficiency of vital medical resources. The limited availability of resources further restricts the accessibility of obstetric fistula treatment treatments (Tebeu et al., 2022). Hence, a significant number of women persist in experiencing this avoidable and manageable ailment, resulting in grave bodily, psychological, and social repercussions. Hence, the study investigate the barriers to accessing treatment for obstetric fistula in among women in Northern Nigeria.

1.3 Objective of the study

The broad objective of the study is to investigate the barriers to accessing treatment for obstetric fistula in among women in Northern Nigeria. The specific objectives is as follows

To identify the socio-cultural factors that contribute to the delay in seeking treatment for obstetric fistula among women in Northern Nigeria.

To evaluate the economic barriers that prevent women from accessing obstetric fistula treatment in Northern Nigeria.

To determine the psychological barriers that affect the decision to seek treatment for obstetric fistula among women in Northern Nigeria.

To recommend strategies for improving access to obstetric fistula treatment in Northern Nigeria.

1.4 Research questions

The following questions have been prepared to guide the study

What are the socio-cultural factors that contribute to the delay in seeking treatment for obstetric fistula among women in Northern Nigeria?

What are the economic barriers that prevent women from accessing obstetric fistula treatment in Northern Nigeria?

What are the psychological barriers that affect the decision to seek treatment for obstetric fistula among women in Northern Nigeria?

What are the recommend strategies aimed at improving access to obstetric fistula treatment in Northern Nigeria?

1.5 Significance of the study

The study will be significant to the ministry of health as it will identify the barriers that prevent women from accessing treatment for obstetric fistula, the study will provide valuable insights into the specific challenges that need to be addressed. This can inform the development of targeted interventions aimed at improving healthcare access for affected women, potentially leading to more timely and effective treatment. 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 the barriers to accessing treatment for obstetric fistula in among women in Northern Nigeria. Empirically, the study will identify the socio-cultural factors that contribute to the delay in seeking treatment for obstetric fistula among women in Northern Nigeria, evaluate the economic barriers that prevent women from accessing obstetric fistula treatment in Northern Nigeria, determine the psychological barriers that affect the decision to seek treatment for obstetric fistula among women in Northern Nigeria and recommend strategies for improving access to obstetric fistula treatment in Northern Nigeria.

Geographically, the study is delimited to Zamfara 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 characterized by an abnormal opening between a woman's birth canal and her bladder or rectum, resulting from prolonged, obstructed labor without adequate medical intervention. It leads to continuous and uncontrollable leakage of urine or feces.

Treatment Access: The ability of individuals to obtain necessary medical services, including the availability, affordability, and acceptability of healthcare facilities, professionals, and treatment options.

Socio-cultural Factors: The social and cultural practices, beliefs, norms, and values that influence individuals' behaviors, decisions, and interactions within a community. In the context of this study, these factors may include stigma, gender roles, and traditional practices that affect women's health-seeking behaviors.

Economic Barriers: Financial constraints that hinder individuals from accessing necessary services, including costs related to medical treatment, transportation, and loss of income. For this study, economic barriers may include poverty, lack of financial resources, and the high cost of obstetric fistula surgery.

Healthcare Infrastructure: The physical and organizational structures, facilities, equipment, and personnel required to deliver healthcare services. In this study, it refers to the availability of hospitals, clinics, specialized centers, and trained healthcare professionals capable of treating obstetric fistula.

Social Stigma: The negative perception and discrimination faced by individuals within a community due to a particular condition or characteristic. In the context of obstetric fistula, stigma may lead to social isolation and discourage women from seeking treatment.

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