Socio-cultural and religious factors affecting obstetric fistula in an Islamic population in Northern Nigeria (Kano State): An exploratory study

Obstetric fistula, caused by obstructed labor, typically results in infant death and in serious medical sequelae for the mother, including unrelenting incontinence of urine and, sometimes, feces. Northern Nigeria has one of the world's highest rates (3.5/1,000 births). Within an ecological framework this study explored socio-cultural and religious beliefs and practices influencing obstetric fistula development in Kano state. Interviews were conducted with 23 fistula repair patients, 23 family members, 9 health service providers, seven imams and numerous key informants (government and NGO officials, community leaders). Ten community focus group discussions were conducted in two rural villages: Makoda and Kore. In strong evidence were the “three delays” of maternal mortality (delays in seeking appropriate medical care in an emergency, in reaching an appropriate facility, and in receiving adequate care at the facility). Noteworthy in community practices contributing to the delays, and obstetric fistula, was a reliance on faith-based and traditional remedies before resorting to hospitals (drinking koranic verses in water, prayer, herbs); insufficient community systems to address obstetric emergencies; and key decisions in delivery being taken by husbands and mothers-in-law who, unlike pregnant women, were not included in antenatal care (ANC) services. Important to prevention will be (i) engaging husbands and older women in ANC services where they learn appropriate responses to obstetric emergencies, and (ii) working with religious leaders, communities, and providers to encourage and achieve safer emergency obstetric care responses. Important to the latter will be making hospitals more appealing, accessible environments for this highly religious population.