While precise figures are not available, it is estimated that more than 2 to 3.5 million girls and women live with untreated obstetric fistula with an added incidence of 50,000 to 100,000 new cases each year, mostly occurring in sub-Saharan Africa and Asia. Obstetric fistula disproportionately affects women and girls in low-resourced parts of the world. This condition may be further complicated by infection, vaginal ulcers, scarring, and stillbirths, which are seen in 78 to 95% of cases. The necrotic tissue sloughs off, usually within three to ten days postpartum, and a hole develops in the birth canal which subsequently results in uncontrollable leakage of urine and/or feces through the vagina. The vaginal soft tissue is compressed against the bony pelvis of the woman during labour and, if there is no timely intervention (such as emergency caesarian section), the vaginal tissue becomes necrotic. This condition results when labour is prolonged and the presenting foetus becomes impacted within the birth canal. Obstetric fistula is an abnormal hole in the vaginal wall which links into the bladder (vesico-vaginal fistula) or the rectum (recto-vaginal fistula) or both. The most severe long-term complication of prolonged, obstructed labour during childbirth is obstetric fistula. Future policies and programs to eliminate obstetric fistulas should include perspectives of nurses, midwives, researchers and, women’s interest groups. Additionally, a policy to end obstetric fistulas in Nigeria must purposefully address the factors creating barrier to women’s access to quality maternal healthcare services. Specifically, a clear commitment to eradicating obstetric fistula would see the constitution and Marriage Act of Nigeria specify an age of consent that is consistent with the agenda to prevent obstetric fistula. This analysis establishes that the Nigerian constitution, justice environment and the obstetric fistula policy itself do not demonstrate clear commitment to eradicating obstetric fistula. Although the policy is ostensibly based on principles of social justice and equity, several rhetorical positions suggest that the Nigerian constitutional environment and justice systems make no real provisions to protect the reproductive rights of girls in accordance with the United Nations’ “2030 Agenda for Sustainable Development.” Conclusion
Furthermore, the extent to which subnational stakeholders in government and civil society were engaged in decision-making process for developing this policy is ambiguous. The policy language suggests victim blaming. The overall orientation of the policy is downstream, with minimal focus on prevention. The analysis demonstrates that, despite its title, the policy document focuses on reduction rather than elimination of obstetric fistula. We used the three phases of critical discourse analysis: textual analysis, analysis of discourse practice, and analysis of discursive events as instances of sociocultural practice. We examined four policies in addition to the strategic framework: the Nigerian constitution the Marriage Act the Matrimonial Causes Act and the National Reproductive Health Policy. MethodsĪ critical discourse analysis of the policy was performed. To further inform future policy directions on obstetric fistula in Nigeria, this paper explores how the NSFEOF conceptualized obstetric fistula and its related issues, including child marriage and early childbearing. The framework has since lapsed and there is no tangible evidence that the goal of eliminating obstetric fistula was met. In 2012, Nigeria’s Federal Ministry of Health published its National Strategic Framework for the Elimination of Obstetric Fistula (NSFEOF), 2011–2015.