AN ASSESSMENT INTO THE ROLE OF EARLY MARRIAGE IN THE PREVALENCE OF OBSTETRIC FISTULA IN NORTHERN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

An obstetric fistula is a severe birth injury marked by an irregular opening between a woman's vaginal system and her urinary tract or rectum. It occurs when labour is protracted and blocked without prompt medical care. Women who are afflicted by this condition have incontinence, which often results in social shame and significant psychological suffering (Wall, 2022). Obstetric fistula is widespread worldwide in low-resource geographical areas with inadequate availability of high-quality maternal healthcare, especially in sub-Saharan Africa and some regions of South Asia (Tebeu et al., 2022). Northern Nigeria has emerged as a central area of focus for the debate on obstetric fistula, mostly because of its elevated prevalence, which is often associated with traditional customs like early marriage (UNFPA, 2018).

Early marriage is a legal arrangement when one or both individuals involved are below the age of 18, often involving females who are much younger than their male counterparts (UNICEF, 2015). The tradition is prevalent in Northern Nigeria, where it is firmly established upon cultural, religious, and socio-economic considerations. In order to provide financial security or meet religious or societal responsibilities, families often arrange marriages for young girls (Cook, Dickens, & Syed, 2015). Although marriage at a young age is expected to provide economic security for girls, it unintentionally exposes them to substantial reproductive health hazards, especially in areas with inadequate healthcare facilities. Premature marriage in Northern Nigeria is a major factor in the elevated prevalence of obstetric fistula. There is a larger likelihood of early pregnancy among girls who are married at a young age. This is because their bodies are not yet completely matured, which increases their susceptibility to difficulties such as obstructed labour, which may lead to the creation of fistulas (Muleta et al., 2017). The fact that the socio-economic environment of Northern Nigeria is marked by elevated poverty rates, poor levels of literacy, and restricted availability of healthcare services exacerbates the issue. A significant number of these young girls do not have access to the essential prenatal and obstetric treatment that may have prevented extended labour and subsequent fistula formation.

Obstetric fistula has significant health implications, typically resulting in persistent incontinence, recurring infections, and, in many instances, infertility (Bangser, 2016). The physiological burden of this ailment is intensified by its societal ramifications, as women afflicted with obstetric fistula usually face social exclusion from their family and communities owing to the odour and negative perception linked to the affliction. Persistent seclusion often results in psychological distress, such as sadness and anxiety (EngenderHealth, 2022). In a society where women's social standing is strongly linked to their capacity to have children and carry out their marital responsibilities, females with obstetric fistula experience significant marginalisation (UNFPA, 2018). Moreover, the severe economic consequences for women who are afflicted are substantial. Fistula-affected women often face limitations in their ability to participate in economic endeavours, either as a result of their physical state or their social isolation. Consequently, individuals develop a financial reliance on others, which often worsens their poverty (Pope, Bangser, & Harris, 2017). In the context of Northern Nigeria, where poverty is prevalent, the presence of obstetric fistula imposes a substantial cost on both families and society. Nevertheless, in the last ten years, several efforts have been implemented to tackle the problem of obstetric fistula, such as the establishment of surgical repair facilities and improved availability of maternal healthcare. The United Nations Population Fund (UNFPA) and similar organisations have initiated awareness campaigns and medical treatments with the objective of avoiding fistula by enhancing maternal healthcare and advocating for gender equality (UNFPA, 2018). However, these attempts have often been hindered by entrenched cultural customs such as early marriage, which persistently contribute to the prevalence of fistula in the area. Premature marriage continues to be a major obstacle in the effort to decrease obstetric fistula levels in Northern Nigeria. In spite of the existing legal structures that prohibit child marriage, the implementation of these laws is still inadequate, and cultural customs continue to prevail, often giving more importance to the family's interests rather than the physical and mental health of young girls (UNICEF, 2015). Therefore, the researcher sought to assess the role of early marriage in the prevalence of obstetric fistula in Northern Nigeria.

1.2 Statement of the problem

The frequency of obstetric fistula in Northern Nigeria is still a major public health concern, attributable to cultural traditions such as early marriage. Early marriage, defined by marriage occurring previous to reaching the age of 18, often results in early childbirth, therefore increasing the likelihood of extended or blocked labour, which is a prominent factor contributing to obstetric fistula (Wall, 2022). Premature marriage of young girls in rural regions is often accompanied by a lack of sufficient maternal healthcare facilities, which worsens the difficulties experienced after delivery (Muleta et al., 2017). The prevailing cultural and socio-economic influences in Northern Nigeria foster the phenomenon of early marriage, thus constraining the educational and economic prospects of young girls, so increasing their susceptibility to negative maternal health consequences (UNICEF, 2015). Contrary to the many attempts made by government and non-governmental organisations to tackle the problem, the significant occurrence of obstetric fistula in the area indicates a need for more focused treatments. Hence, the need to assess the role of early marriage in the prevalence of obstetric fistula in Northern Nigeria.

1.3 Objective of the study

The broad objective of the study is to assess the role of early marriage in the prevalence of obstetric fistula in Northern Nigeria. The specific objectives is as follows

To examine the prevalence of early marriage in Northern Nigeria

To investigate how early  marriage played a role in the contraction of obstetric fistula among young women in Northern Nigeria

To identify the barriers to healthcare utilization that prevent young women from receiving timely obstetric care during labor.

To proffer strategies aimed at reducing early marriage and its associated health risks in Northern Nigeria.

1.4 Research questions

The following questions have been prepared to guide the study

What is the prevalence of early marriage in Northern Nigeria?

How has early  marriage played a role in the contraction of obstetric fistula among young women in Northern Nigeria?

What are the barriers to healthcare utilization that prevent young women from receiving timely obstetric care during labor?

What are the strategies aimed at reducing early marriage and its associated health risks in Northern Nigeria?

1.5 Significance of the study

Findings of the study will reveal critical health risks faced by young girls in Northern Nigeria. The findings will inform healthcare practitioners and policymakers about the importance of improving maternal healthcare services, particularly in rural areas, to prevent obstetric complications associated with early pregnancy. 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 role of early marriage in the prevalence of obstetric fistula in Northern Nigeria. Empirically, the study will examine the prevalence of early marriage in Northern Nigeria, investigate how early  marriage played a role in the contraction of obstetric fistula among young women in Northern Nigeria, identify the barriers to healthcare utilization that prevent young women from receiving timely obstetric care during labor and proffer strategies aimed at reducing early marriage and its associated health risks in Northern Nigeria.

Geographically, the study is delimited to Biriniwa LGA, Jigawa 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

Early Marriage: The formal or informal union between two individuals where at least one person is under the age of 18, often associated with significant health, social, and educational risks for the young bride, particularly in low-resource settings .

Obstetric Fistula: A medical condition in which a hole develops between the vagina and bladder or rectum due to prolonged, obstructed labor without timely medical intervention, leading to incontinence and severe health and social consequences.

Maternal Health: The health of women during pregnancy, childbirth, and the postpartum period. It encompasses the prevention and treatment of maternal morbidity and mortality and the provision of safe childbirth services.

Socio-Cultural Factors: The combined influences of social norms, traditions, customs, and beliefs that shape behaviors and practices within a community. In this context, these factors often perpetuate early marriage in Northern Nigeria.

Healthcare Access: The ability of individuals to obtain and utilize health services. It includes factors such as availability, affordability, and quality of healthcare facilities, particularly during pregnancy and childbirth .

Prolonged Labor: A labor that lasts longer than 20 hours for a first-time mother or more than 14 hours for women who have previously given birth. Prolonged labor increases the risk of complications such as obstetric fistula .

Poverty: The state of having little to no financial resources, which limits access to education, healthcare, and basic services. Poverty is a significant driver of early marriage and poor maternal health outcomes in Northern Nigeria.

Gender Inequality: The unequal treatment or perceptions of individuals based on their gender, leading to disparities in access to education, healthcare, and economic opportunities. Gender inequality is a contributing factor to the persistence of early marriage and related health issues .

Reproductive Health: The complete physical, mental, and social well-being in matters related to the reproductive system and its functions. It includes family planning, maternal care, and protection against sexually transmitted infections.

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