Nigeria: Why Obstetric Fistula Must Be Stopped

13 September 2019

Obstetric Fistula is a medical condition whose leading etiology is "obstructed and prolonged" labor and is a medical condition in which a hole forms between the bladder and the womb ( VesicoVaginal Fistula - VVF) leading to the loss of urine control ability, or between the womb and the rectum (RectoVaginal Fistula - RVF) leading to the loss of stool control ability or even both; thereby rendering her to stool or urine (or both) leakages at all times.

There are congenital forms but most often, it happens when the reproductive structures through which babies are delivered are not mature or developed enough to withstand the delivery process. This leads to obstruction of the baby from being delivered and prolonging the parturition. Intense pressure forms due to the obstruction and causes the fistula formation either between the womb and bladder or between the womb and rectum.

Regrettably, child/early marriage has been proven to be the most prevalent risk factors of this debilitating ailment and unfortunately, it is a practice most common to the Muslim North. We usually give religious justifications whenever arguments concerning early marriage arise, that is why the prevalence is getting higher every passing day.

I rarely comment on issues of religious contradictions but today, the inner thrust has reached a zenith stage that I just have to. Why? Because I've seen live cases of these beautiful, little girls turned something else and it pinched my conscience.

Islam, quite alright does not specify a minimum age for marriage in both males and females but there are conditions regarding physical, mental and emotional maturity. As a Muslim and a student of Islamic principia, I know there are prophetic traditions and Quranic references that have established basic conditions for marriage ranging from reaching comprehensive maturity, mutual consent to issues of dowry agreements.

But one that has stood out to be highly debatable is the issue of the age or level of maturity because the Quran does not define the age at which these range of maturity is attained. What is certain and highly imperative for all of us to understand is that Islam clearly specifies physical, psychological and emotional maturity coupled with sense of responsibility as requirements for marriage.

"And test the orphans [in their abilities] until they reach MARRIAGEABLE age. Then if you perceive in them SOUND JUDGEMENT, release their property to them... ... " Surah An-Nisa [4:6]

Maturity is a concept that is highly variable. It is one thing for a girl to reach physiological maturity (menarche) but the attainment of an age that guarantee sense of responsibility, comprehensive judgment abilities and sexual maturity (development) is another issue entirely. They don't usually happen in sync!

However, it has been empirically proven that at 18 years, it is expected that all these aspects of maturities have been established. Islam also spells out that a Muslim is expected to obey the rules of the land in which he lives and most countries, international conventions and regional laws like the UN Convention on the rights of a child (Article 1), the convention on the elimination of All Forms of Discrimination Against Women (General Recommendation 21) and the 1990 African Charter on the Rights and Welfare of the Child (Article 21) have pegged the marriage minimum age at 18 years.

Furthermore, in Islam there is a "NO HARM" principle as the prophet (PBUH) said; "there shall be no harm and no reciprocation of harm. Whoever harms, Allah will harm him, and whoever makes things difficult (for others), Allah will make things difficult for him".

Protection of life and health remains an ideal guide in every decision making process in Islam for it is one of the essential goals(maqasid) of Sharia. The fact that reports and researches have found that pregnancy before the age of 15 poses double risk of Obstetric Fistula and Maternal Death than older marriages and that the WHO describes fistula as "the single most dramatic aftermath of prolonged and neglected childbirth" puts child/early marriage in contravention with the Islamic obligation to protect human life and health.

Islam also mandate parents to take charge of their children's moral and religious developments (tarbiyyah), this obviously can only be achieved by a psychologically and emotionally matured mother.

For God sake, the prophet (PBUH) even said "whosoever supports two daughters until they mature, he and I will be on the day of judgment as this (and he pointed with his two fingers held together)".

What justification do we have then to continue this practice and continue adding to the already established 12,000 yearly new cases out of which only 5,000 get repaired? With 12,000 new cases every year and a huge backlog of almost 200,000 women waiting for fistula surgeries, Nigeria remains the country with the highest occurrence of obstetric fistula. Yet, most fistula repair facilities depend on funds from international donor agencies.

Unarguably, the solution to this requires both citizen and governmental commitments. The government needs to pass suitable and consensus based legislation as regards to the minimum age for marriage and protection of the girl child as enshrined in the Childs Rights Act while committing herself to also taking charge of fistula treatments across the country.

We the citizens also have to invoke the commitment we have taken upon ourselves as regards to helping the government in achieving the Sustainable Development Goals by mobilizing the communities mostly affected and enlightening them on this serious issue, for the only way we can achieve the eradication of Obstetric Fistula is by minimizing the causes and risk factors while concurrently supporting our Fistula Repair Facilities with the necessary tools and well trained personnel.

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