Adama (not real name) was married at 13 and got pregnant at 14. She has never visited the hospital for antenatal or any form of medical care. Her case is the norm in Borno State, where she hails from.
When HumAngle visited her, her eyes conveyed the pains that came from her fight with Vesicovaginal fistula (VVF).
VVF is an abnormal fistulous tract extending between the bladder (vesica) and the vagina that allows continuous involuntary discharge of urine into the vaginal vault.
In addition to the medical sequela from these fistulas, they often have a profound effect on the patient’s emotional well-being.
The annual obstetric fistula incidence is estimated at 2.11 per 1,000 births. It is more prevalent in Northern Nigeria.
To some cultures in Borno, Northeast Nigeria, early marriage is a tradition and not seen as a human rights violation, regardless of the obvious trauma these children go through when they are married so early.
Adama, who is now 25 years old and has five children, hails from Bama Local Government Area. She told HumAngle, “I survived the pregnancy but I faced difficulties in the process of keeping my pregnancy safe.
“I got married to Musa at the age of 13. I got pregnant a year after my marriage and I will say that I have suffered.
“I do my house chores, work at the farm and at the same time, cook for my husband and children.
“I have never visited a hospital, even for checkup of antenatal care. I was delivered at home by midwives, who process most of the deliveries in our community.
“It was in the process of childbearing that I got VVF where I was injured in the bladder,” she narrated.
When she got infected, her husband left her for another woman whom he married and abandoned her.
“I got pale and lacked blood and energy but at last, I was divorced. Because of my health condition, he left me with the children. I cater for their needs. He abandoned me,” Adama said.
Her story is similar to that of Fatima Zarma who got married at 12. The Mafa Local Government Area indigene had her baby in the farm.
She recalled that there was no attendant to help her and the baby came out while she was on the farm, collecting vegetables for the family’s pot of soup.
“I was in pain. I did not know it was labour. I was having contractions but I thought it was normal pain.
“Few hours later, the pain was so much that I sat on the ground in the farm unaware that the baby was coming. I delivered the baby in the bush alone.
“I bled till I gathered strength to run out of the bush for help when a neighbor helped me call a midwife in our village,” Fatima painfully narrated to HumAngle.
Few weeks later, she fell sick and visited the hospital where the doctors confirmed that she had a “strong infection”.
The doctor said it was as a result of the labour and delivery process that the baby also fell sick and died after five weeks.
The doctor explained that the baby suffered prolonged labour which caused abnormalities on it.
He stressed that because of her age, Fatima had a narrow pelvis which also contributed to the infection and the child’s death.
Fatima is 35 years old now and has four children.
She said, “I have so many infectious diseases that prolonged my deliveries due to the infection I got from my first baby. I live with the infections now.”
HumAngle also met Sadiya Mai, who got married at 13. She has seven children and all were delivered by the local birth attendant.
On hospital visits, she said, “I am not aware of deliveries in hospitals as all the mothers I know delivered at home.
“We don’t go to hospitals for any treatment. We use traditional medicine for all our sicknesses. All my children were delivered at home,” she said.
Mai, however, revealed that she had serious bladder and abdominal pains, which are signs of VVF.
Doctors have explained that it could be as a result of tight pelvis and forced labour.
Mai’s first baby survived but with some health challenges. She is 17 years old and cannot talk.
Doctors explained to HumAngle that the challenges could not be corrected and Mai, reflecting, said, “I am not happy with the way she is.”
Dr. Mahdi of Umoru Shehu Ultra Modern Hospital told HumAngle that VVF was caused by obstructed labour and early marriage was among the major causes.
He said, “Fistula is a common problem that has public health significance. It may be caused by infection or congenital birth condition.
“A prolonged labour process pushes the unborn child tightly against the pelvis thereby cutting off the blood flow to the vesicovaginal wall.
“Fistula must be treated because it will not heal on its own, and will pose a risk of developing cancer in the fistula tract if left untreated for a long period of time,” he said.
To avoid rampant cases of Fistula, he advised that early marriage should be discontinued and female children enrolled in school to get educated.
He also noted that more awareness needed to be created on the subject as well as the need to discourage early marriages.