“Social Pariah:” Practitioner and patient responses to global health discourses about obstetric fistula in Nigeria

Many popular and scholarly public health writers portray women with obstetric fistula (OF) as “social pariahs,” divorced by patriarchal men and deserted by their families to beg in overcrowded African slums.  A condition of continual urine and/or fecal leakage, obstetric fistula most commonly results from prolonged, obstructed labor or failed obstetric surgery. Emergency, good-quality obstetric care can prevent OF.  This study aimed to explore how OF patients and practitioners at four treatment centres in Nigeria describe the causes and consequences of OF.

A cross-sectional, qualitative-based study was conducted with 140 respondents at four OF treatment facilities and fifteen governmental and non-governmental agencies in five States across Nigeria. Research methods included participant observation, in-depth interviews and focus group discussions.  Respondents were pre/post-operative OF patients, clinicians, policymakers, and health professionals.

Principal findings demonstrate discrepant views between practitioners and patients during discussions about OF effects. Most practitioners described women with OF as “smelly,” “pathetic,” “hopeless” “victims” who resort to begging or prostitution to survive.  They see surgical treatment and biomedical education as only way to heal these women.  Patients’ stories efface these pathologizing representations. Many women outlined dynamic strategies they developed to manage their leakage, to maintain marital relationships, to care for their families, and to keep/gain employment.

Experiences living with and seeking treatment for OF reflect the material and social realities of women in Nigeria.  As global health professionals, we must tailor policies and programs that both depict and resolve the diverse health, familial and socioeconomic concerns of women living with OF.