At just 17 years old in 2018, Sheituna Saani, from Kwaranyi in Niger State, was forced out of school and married off by her parents.
Like many girls in her community, marriage came with early pregnancy. In her village, childbirth is handled almost entirely by traditional birth attendants because the nearest hospital is nearly 50 minutes away from where they call home.
Although her first two deliveries were far from easy, the fourth pregnancy turned her life into chaos.
Mrs Saani experienced excruciating labour for three days under the care of the local birth attendant, unaware that her baby was trapped in her birth canal.
When she eventually lost consciousness, she was rushed to the Kontagora General Hospital, where she woke to the devastating news that her baby had died due to the prolonged labour.
While she mourned her loss, she realised she could no longer control her urine. A doctor later confirmed that she had developed an obstetric fistula, a childbirth injury that causes uncontrollable leakage.
A cure out of reach
“When they told me about the sickness, I cried and prayed that Allah (God) should just take my life,” Mrs Saani said.
“The doctor advised my husband and me that I just need good care and told us that I could find a cure, but we later found out it takes a huge amount of money to perform the surgery after they referred me to a hospital in Kaduna.”
Desperate for relief, she turned to local herbs, but instead of improving, her condition worsened.
The constant leakage eventually caused peripheral nerve damage in her legs, which made mobility difficult for her.
The physical pain, constant humiliation, and social rejection shattered her confidence and plunged her into deep poverty, shame, and isolation. Her husband later returned her to her parents’ house and barely visited before ultimately divorcing her.
“I lost everything. My husband left me, too. He sent his friend to inform me that he was no longer interested in our marriage. Everyone, including our neighbours, started avoiding me,” she recounted.
“They always make me feel unfit to live around them. If they are in a group and see me approaching, they will depart to avoid meeting with me. They often call me a smelly woman.”
The same tragedy
Mrs Saani is not alone. In 2021, Zainab Shefiu, now 25, had prepared to welcome her first child joyfully. But like many rural communities in Niger state, hers lacked a functional health centre.
“When I started labour, my husband went to call a nurse from a nearby village to help me with the delivery. I couldn’t deliver until after many hours, and they told me that my twin babies had died,” she recalled.
“Later, I noticed I’m leaking urine and faeces. That was how the trouble started.”
The prolonged labour had left Mrs Shefiu with both vesicovaginal fistula (VVF) – uncontrolled urine leakage and rectovaginal fistula (RVF) – (faecal leakage).
She noticed people around her started treating her with disdain because of her condition. She had solely depended on her husband for livelihood, but since her husband was gone, her parents were left to piece together a life once held up by his support.
“Everyone, including our neighbours, started avoiding me. I became like a baby who can’t control her urine and faeces. I always felt ashamed of myself because I couldn’t hold my body, and everywhere I stayed would become stinky,” she said.
“When they started mistreating me and laughing at me, I stopped going out. Only a few of my family are helping and supporting me with care and money for my drugs.”
Obstetric fistula
Obstetric fistula is one of the devastating childbirth injuries, particularly affecting women and girls in communities with limited access to timely medical care.
It develops when prolonged or obstructed labour, often lasting many hours or even days, creates an abnormal opening between the birth canal and nearby organs, leaving women unable to control the passage of urine, faeces, or sometimes both.
Experts say similar cases could arise due to other gynaecologic or obstetric surgery, such as complicated delivery or injury during a Caesarean section. While the condition is preventable and curable, it remains tragically common in Nigeria, where early marriage, teenage pregnancy, and long delays in reaching health facilities put young mothers at high risk.
Vesicovaginal fistula (VVF) is a type of fistula that occurs when a hole forms between the bladder and the vagina, causing uncontrollable urine leakage; while rectovaginal fistula (RVF) develops between the rectum and the vagina, leading to stool leakage.
In some cases, women like Ms Shefiu experience both conditions, especially after significantly prolonged labour.
According to the United Nations (Nigeria), over two million women worldwide are estimated to be living with untreated fistula and up to 100,000 new cases are recorded each year. Meanwhile, 40 per cent of global fistula cases occur in Nigeria, with 13,000 new cases added annually, underscoring the country’s poor maternal and neonatal healthcare system.
Additional data revealed that fistula accounts for up to six per cent of all maternal deaths globally, and 90 per cent of women who develop fistula lose their baby to stillbirth or the baby dies within the first 24 hours.
In Nigeria, one in 13 women dies during pregnancy or childbirth, and the stillbirth rate is 42.9 per 1,000 births, the highest in Africa and second highest worldwide.
In her message to commemorate the 2025 International Day to End Obstetric Fistula, the Executive Director of UN Women, Sima Bahous, said women’s bodies become battlegrounds – not only through sexual violence but through the deliberate denial of reproductive rights and health services.
Ms Bahous painted a grim picture of what people living with obstetric fistula go through, especially the complications that it causes during childbirth.
“Five days – that is how long it took Dah, a 14-year-old prospective mother from Côte d’Ivoire, to give birth. The child was stillborn, and she developed an obstetric fistula,” she said.
“16 years – that is how long Dah had to live with the agonising condition, undergoing eight different surgical procedures before finally getting the fistula repaired.”
More than just a health issue
While Mrs Saani and Mrs Shefiu’s experiences are heartbreaking, many other women are suffering the same fate.
Clementina John, 21, who lives in Zayba, near the Niger-Kebbi border, gave birth to her baby at a community-built health centre. Her delivery went well, but almost a week later, she noticed she was leaking urine.
She was diagnosed with an obstetric fistula and had to relocate to Kwankoso to live with a relative who could care for her.
“We have a health centre, but it is not adequate; that is where we used to deliver, but mine is just God’s destiny. I had to go live with my uncle in another community for proper care because my husband works as a gateman in the town; he only returns home every two days,” Mrs John said.
More contributing factors, rising cases
Experts have noted that other factors, including social-cultural beliefs and practices like child marriage, Cephalo-pelvic disproportion (CPD) due to malnutrition, and female genital mutilation (FGM), which accounted for 15 per cent of cases of VVF in some areas of Africa, contributed to the rising cases of fistula.
In Nigeria, despite the Child Rights Act (2003) prohibiting child marriage, the practice remains prevalent. About 30 per cent of the girls are married before the age of 18, one of the highest child bride rates in the world.
This amounts to nearly 20 million girls entering unions, many of whom become mothers while still physically immature.
However, early pregnancy significantly increases the risk of complications such as obstructed labour and fistula.
The highest rates of young motherhood are found in the Nigerian northwestern and northeastern regions, where marriages are often arranged by fathers and timed according to tradition.
Also, chronic malnutrition, especially during adolescence, can stunt pelvic growth, leaving young women with underdeveloped pelvises that are too narrow for childbirth, significantly increasing the risk of obstructed labour.
In Nigeria, seven per cent of women of reproductive age suffer from acute malnutrition. Global data confirm that malnutrition and stunted growth are recognised as risk factors for obstructed labour and fistula.
Suleiman Taofeeq, an obstetrician and medical director of Rise Foundation’s Women’s Health Centre in Kontagora, said there are other, less common types of fistula that can result from severe trauma, reproductive surgeries, or radiation therapy.
“But majorly, the injury is a consequence of neglected prolonged labour and babies from such labour are often stillborn or die in the first few hours or days after birth,” he said.
Prevention rather than treatment —A Call for urgent action
In 2019, the Nigerian government launched a National Strategic Plan to eliminate obstetric fistula in the country by 2023, with a focus on prevention, treatment, and rehabilitation. However, implementation faced setbacks due to poor funding, limited awareness, and slow state-level adoption, which worsened the country’s fistula cases.
Also, in 2024, the government introduced the Fistula Free Programme through the National Health Insurance Authority (NHIA), offering free surgical repairs and support to affected women.
This initiative builds on the 2019 framework and represents a renewed commitment to tackling the backlog of cases and expanding access to care for the victims.
It also expanded health insurance coverage for the treatment of obstetric fistula. The initiative currently has 18 health facilities across the geo-political zones treating affected women, and has successfully treated 1,629 women with fistula as of January, according to the Coordinating Minister of Health & Social Services, Muhammad Pate.
Mr Pate added that 15 specialist surgeons are undergoing training through the International Federation of Gynaecology and Obstetrics (FIGO) across the three levels of expertise required.
He thanked the national Non-Governmental Ormganisations like Raised Foundation, Bashir Foundation for Fistula and Women’s Health (BFFWH), Fistula Foundation Nigeria, and international partners like the United Nations Population Fund (UNFPA) that have been supporting affected women with surgical repairs and livelihood opportunities to reintegrate them back to the communities that once rejected them.
The backlog remains massive
Despite these efforts, the scale of Nigeria’s fistula burden far exceeds available resources. Over 100,000 women are still awaiting treatment, with roughly 13,000 new cases occurring each year.
To effectively tackle this backlog and prevent future cases, experts say Nigeria must strengthen its maternal healthcare system, especially in underserved and rural areas, where delays in emergency care and skilled birth attendance continue to fuel new cases.
Akinde Joseph, a Lagos-based gynaecologist and obstetrician, explained that eliminating obstetric fistula requires a holistic overhaul of the maternal health system and the implementation of child marriage rights.
Mr Joseph noted that “Most fistula cases are rooted in weak primary healthcare, delays in accessing emergency obstetric care, and a shortage of skilled birth attendants in rural communities. So, we can’t keep repairing what the system keeps breaking.”
He, however, called for investments in antenatal care, rural health infrastructure, referral systems, and nutrition for adolescent girls.
“Without addressing these underlying causes, the backlog of fistula cases will persist no matter how many repair campaigns are launched,” Mr Joseph said.
He stated that young women, particularly those married off in their teenage years, are especially vulnerable to this condition “because their birth canals are not fully matured before their first pregnancy.
For women like Mrs Saani, Mrs Shefiu, and others across rural Niger State, obstetric fistula is not just a medical condition; it is a life-altering crisis that steals dignity, disrupts families, and pushes survivors into social isolation.
Their suffering highlights the gaps in Nigeria’s maternal healthcare system, delayed access to obstetric care, under-resourced health facilities, a shortage of skilled birth attendants, and deeply entrenched social practices such as child marriage.
