Africa, Development & Aid, Headlines, Health, Poverty & SDGs

HEALTH-NIGER: Enlisting Men in the Fight Against Fistula

Ousseini Issa

NIAMEY, Nov 23 2004 (IPS) - When poverty and traditional practices collide in Niger, the results can be ruinous – particularly for teenage girls.

Cultural norms dictate that girls should get married early in this West African country: according to various surveys, the average age for marriage amongst females in Niger is 13. As a result, many find themselves giving birth before they have properly left childhood behind themselves. First pregnancies usually occur before the age of 19.

But when children give birth to children, complications ensue – not least those created by obstetric fistulas.

As IPS has previously reported, the United Nations Population Fund (UNFPA) and various non-governmental organisations (NGOs) have launched initiatives in Niger to care for girls and women who develop fistulas.

But, what of the men who allow this condition to persist by marrying girls who are too young? If prevention is better than cure, are efforts underway to alter their perceptions about the age at which is it acceptable for girls to be married?

The answer to these questions may lie with men like Mamoudou Seybou. With his daughter, Sakina, hospitalised with fistula, Seybou’s face clouds with bitterness at the mere mention of the word.


“Sakina had complications during the birth of her first child and became incontinent. Since she took some time to recover, her husband ultimately abandoned her to her fate,” he told IPS.

“I decided to marry her off very early for fear that she might get pregnant out of wedlock, which is common these days. I thought it was for her own good. But I realised too late that I ruined her life. I feel responsible for what happened to Sakina and I don’t wish this kind of tragedy on any parent,” he adds.

As a result of this experience, Seybou – who lives in Torodi, some 50 kilometres from the capital, Niamey – has joined in the fight to eliminate obstetric fistulas in Niger.

The condition occurs as a result of prolonged obstructed labour, often when a girl’s body is too immature – her pelvis too small – to accommodate the baby as it passes through the birth canal. Labour may also become problematic when a child is too big, or badly positioned for birth.

Obstructed labour cuts off the supply of blood to parts of the vagina, bladder and sometimes also the rectum, causing the tissue there to die and rot away. A hole later forms in this area that allows for the uncontrolled flow of urine and fecal matter.

The resultant mess and stench may lead to the girl being abandoned by her husband, and ostracized by other members of society. As fistula sometimes leads to infertility, women who live in communities that frown on childlessness may find themselves further isolated.

While the condition can be repaired with a relatively simple operation, this surgery is normally too costly for the girls and women from poor areas who typically develop fistulas. Statistics on the number of fistulas in Niger can be difficult to come by; but, the UNFPA estimates that more than two million people around the world suffer from the condition.

In wealthy countries, the use of caesarian sections has largely eradicated fistulas. However in Niger, where just four percent of girls and women have access to this procedure, preventive surgery doesn’t hold out much hope. Once again, the urgency of modernizing perceptions about the role of women in society becomes apparent.

A number of groups in the country are targeting men in campaigns to rid Niger of fistulas.

One of these initiatives dates back to January 2002, when a National Forum on Early Marriage in Niger was held in Maradi, a city located about 600 kilometres east of Niamey, by the Association of Traditional Chiefs of Niger (Association des chefs traditionnels du Niger, ACTN). The UN Children’s Fund (UNICEF) provided assistance for this gathering.

“At the end of the forum, we decided to conduct an information campaign in all our villages, calling upon the services of those who traditionally broadcast our messages, who include…marabouts, griots, blacksmiths, hairdressers and butchers,” Amirou Alhassane Albadé, assistant general secretary of the ACTN, told IPS. (A “griot” is a traditional storyteller in West Africa, while a “marabout” is an Islamic religious figure.)

UNICEF-trained workers also assist chiefs in spreading the word about the dangers of fistula. In certain instances at least, it appears the message is taking hold.

“It’s poverty and ignorance which move us to marry off our daughters too early. But as we now understand the risks such practices expose them to, we can no longer allow ourselves to sign away their futures,” a father from Libore, a village just outside Niamey, told IPS.

Another man, Issoufou Boube, was interviewed at the recently-opened Reception Centre for Women with Fistulas in Niamey, where his wife was a patient.

“I felt at least partly responsible for my wife’s fistula. I should not have agreed to live with her before she came of age,” he told IPS. “But you know that in our society, it’s hard to marry and then leave your wife with her parents. They consider her a useless burden as soon as she has a husband.”

Campaigns to prevent early marriage also tend to encourage parents to enroll and keep their daughters in school – something that has incalculable benefits for the girls, the families they go on to have, and society at large.

But, there’s still some way to go in improving girls’ education. According to the Minister of Education, the nationwide rate of primary school enrollment in 2003 was 50.1 percent for boys and 33.3 percent for girls.

In addition, there are few rural schools where girls can pursue secondary education in Niger.

“Girls become vulnerable when they leave their villages for urban areas, to attend secondary schools. Generally, they stay with tutors who don’t always take good care of them,” says Albadé.

“It’s for this reason that certain parents end the schooling of their daughters at secondary level,” he adds.

Religion may also prove an obstacle in convincing people that early marriage isn’t the best choice for girls.

“Obstructive Islamic leaders continue to exercise a bad influence over communities, in the name of religion,” says Moussa Abdou, secretary-general of Reproductive Health for Motherhood Without Risk, a Niamey-based NGO. (Ninety percent of Niger’s population is Muslim).

Islamic specialist Boureïma Daouda says those leaders who do so are misinformed.

“Despite what some say, Islam does not encourage early marriage…Neither does it recommend marriage to girls before they have reached puberty,” he told IPS.

“However, if a girl who has not reached puberty is married according to the customs of Islam, that marriage is valid. The parents must decide when the union should be consummated,” he added.

 
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