A girl is not an earthen pot which is tapped at the bottom to confirm its strength. But Amina Musa’s parents did not know that. Hence they pawned her off to Aliyu, a fish merchant and benefactor, who paid her bride price soon after she clocked 10.
Like earthen pot, Amina cracked at the bottom. Four years after she married and divorced 47-year-old Aliyu, she has been unable to conceive of another child. Although the 10-year-old had a child by her husband in the first year of her marriage, the baby was stillborn.
At the advice of his relatives, her husband made her visit a local, herbal doctor for treatment. The latter made incisions on her private part, causing her to experience swollen labia; then pus gathered in her vaginal lips. It took her three weeks to get rid of the abscess and the stench. Afterwards, her husband forced her to revisit the herbalist.
“The herbal doctor inserted herbal medication into my private part for two weeks with the aim of treating my infertility,” she said. According to her, the constituents of the herb were unknown but it was in the form of black soap and dried pellet made of herbal extract.
After seven days of herbal therapy, Amina developed high-grade fever and severe burning sensation in the vagina followed by the sudden onset of continuous leakage of urine with a minute amount of blood through the vagina. She stopped experiencing menstruation too.
Subsequently, she visited a primary health centre where she was later referred to the Aminu Kano Teaching Hospital. There, medical examination revealed scars on and wall of her vagina. Amina leaked urine and fecal matter and a further examination revealed the presence of fistula on the anterior wall of her private part. She was counseled and advised for fistula repair.
But rather than allow her go for treatment, Amina’s husband threatened to divorce her if she did. Her mother pleaded with her, urging her to do her husband’s bidding and shun the doctor’s advice.
“She said doctors would make me disgrace our family. She said the doctors got it wrong and that leakage (obstetric fistulae) was not in the history of our family. She said the slight incontinence that I experienced was due to the effectiveness of the herbal therapy. Mother said the potions I drank were forcing me to discharge spells cast on me by my rival wives. I believed her,” said Amina.
Thus she shunned orthodox medical advice and instead accepted to undergo further herbal treatment. Her ailment worsened and when the stench from her incontinence worsened, Amina’s husband divorced her.
She subsequently went back for corrective surgery, she started experiencing her menstrual cycle after a five-month cessation but on realisation that her husband would not remarry her, Amina stopped going for post-operation treatment.
It’s four years since Amina scorned doctor’s advice for herbal therapy and she has not conceived another child. Now 14, Amina has lost hope of ever remarrying. She relocated to live with her mother’s childhood friend outside Kano city; there she shuttles to and from neighbouring Kaduna “to hustle.”
If Amina’s case is pathetic, Maitara’s ordeal is even more pitiful. Few weeks after the eight-year-old learnt of her betrothal to 59-year-old Salisu Usman, her parents’ landlord and creditor, she was subjected to the gishiri cut.
“They asked me to promise to do our family proud. They said only a bastard child would wail under the blade of gishiri. They said if I struggle and wail, a great curse will fall on me and I would never be able to have a child. I promised to do them proud,” said Maitara.
Thus the eight-year-old went under the blade of gishiri and did them proud. “There were eight women in the room that I was cut. But I could only recognise a neighbour who lived opposite our family house,” she said.
No sooner did she enter than the women grabbed her hands and held her in a tight grip. They tore her pant off; then she felt excruciating pain.
Blood gushed from her private part and cascaded her legs.
Through spasms of pain, the eight-year-old understood that she had become a woman. Three years after she was subjected to the gishiri cut, otherwise known as Female Genital Mutilation (FGM), Maitara’s betrothed came for her hand in marriage. It was a brisk, disorganised affair. “I knew money changed hands between my parents and Salisu but there was nothing I could do. They were indebted to him,” she said.
On the first night of their marriage, 59-year-old Salisu ravaged 11-year-old Maitara pitilessly.
In the morning, he walked out leaving her like a crumpled sheet, slumped across the bed. Under normal circumstances, as an adult bride, she would have experienced bliss the night before but Salisu plunged into her unripe orifice as the proverbial rapist defiles a hopeless and naive girl-child.
“Because I did not open my legs and lay still, he slapped me. When he slapped me the second time, I bit him on the neck. Then he screamed in anger and punched me on both shoulders and my mouth. I became very weak. I could not see clearly anymore and I tasted blood in my mouth. But he was past caring. He tore my pants off and raped me,” said Maitara, adding that she could hear her co-wives giggling in their rooms through her ordeal.
While her husband drifted into sleep immediately after the act, the 11-year-old could not sleep. She bled continuously from vaginal sores and laceration caused by his violent entry into her core.
“I thought I would die before dawn,” said Maitara, but she didn’t. Daylight cracked open her mind and slapped her girlish brain into consciousness, and she subsequently learnt to endure the pain of her vaginal wound and the taunts of her two senior wives.
At her mother’s first visit to her home, Maitara lamented her misery, urging her to take her away but she firmly declined.
“She said I had become a woman. She said I shouldn’t curse or rebuke my husband, that because of what he did to me, I would become more beautiful, have beautiful kids and have a great life. Then she gave me a herbal potion to drink promising me that my genitals would stop bleeding. She said I would not hurt anymore,” said Maitara.
But the pain didn’t stop. Maitara experienced great hurt every time her husband slept with her and for several days, she could not stand or walk upright. Eventually, she became pregnant. However, due to complications from protracted labour, Maitara’s baby died at birth and she suffered a severe case of obstetric fistula.
Despite her incontinence, Maitara’s husband hardly cared. “He did not take me to the hospital until four months after the leakage began. He forced me to drink concoctions prepared by his first wife. But none of the potions worked. I began to stink and I couldn’t stand my own breath.
“During this period, when he slept with me, he covered his nose with a cloth. Then he stopped coming to my room. Afterwards, he took me to the clinic and abandoned me there,” she said.
Maitara could not go back home because of the shame she would attract to her family. Hence one year after she became incontinent, she departed for Nasarrawa to live with a relative. There, she remarried but was later divorced due to her inability to get pregnant.
She said: “The doctors said the injury made me barren. They said my womb is broken and no child will stay in it.”
Now 15, Maitara, plans to relocate permanently to Lagos. “I like this place. Life is easier here than back home,” she said on a brief visit to Lagos.
Doctor’s explanation of Amina and Maitara’s ‘secondary infertility’
Bintu Ahmad, a medical doctor, identified the teenagers’ inability to conceive children even after their stillbirths, as secondary infertility. She described it as a distressing condition, recalling the case of a 33-year-old patient with no living child. “She suffered from secondary infertility presenting with large abdominal mass and severe abdominal pain, of previous obstructed labour. She was young, had no living child, had undergone fistula repair and vaginoplasty yet was wanting fertility. Both she and her spouse were counseled about the high possibility of failure if repeat attempt at vaginoplasty was made, and possible damage to the VVF repair.
“Finally, after further examination and counseling, the couple accepted that the woman undergoes total abdominal hysterectomy (surgical removal of the cervix and the uterus or womb by incision in lower abdomen). The man divorced the lady afterwards,” said Ahmad.
Grim picture
There is no gainsaying obstetric fistulae is a major public health problem in Nigeria. According to a 2010 report by EngenderHealth, an estimated 400,000 Nigerian women and girls suffer from fistula, and approximately 12,000 new cases occur annually. The humanitarian crisis in the North East has exacerbated these conditions as victims of impoverishment, rape and forced marriage by Boko Haram are at risk of experiencing VVF, according to medical expert opinion.
An affliction of the poor?
This injury afflicts society’s poorest and most marginalized; those without access to emergency obstetric medicine.
Fatimatu Saliu, a Zaria-based nurse and social worker, argues that a greater percentage of VVF patients usually fall within the low income and impoverished economic divide. “Many of the victims come from poor homes and their parents marry them off at a tender age for economic gain,” she said.
Customary disaster
The plight of Amina and Maitara, no doubt, illustrates the stark misery characteristic of the world of many child brides in the country. By its magnitude, VVF is a major public health problem in Nigeria. Prevalence estimations range from as low as 100,000 to as much as 1,000,000 cases. Health experts, however, quote 400,000 to 800,000 even as Dutch surgeon, Dr. Kees Waaldijk, who has worked with the Nigerian government to end fistula through his direction of the Nigeria National Fistula Programme, stated firmly that the backlog is 200,000 to a maximum 250,000 patients.
The incidence is currently estimated at 12, 000 new cases a year (an improvement on the 20,000 new cases a year figure of the past) while 90 per cent are untreated. It is estimated that two million women suffer from obstetric fistula globally. In Nigeria alone, the North has over 85 per cent of these cases. The vast majority of VVF is caused by obstructed labour, gishiri (circumcision) cut and obstetrical trauma.
Fistula, the Latin word for “pipe,” is an “abnormal passage” between organs —in this case, between the vagina and the bladder, the rectum, or both. The hole makes the woman uncontrollably incontinent of urine or feces or both.
Obstetric fistula results from obstructed labour, which occurs when the baby cannot pass through the mother’s birth canal because pelvis is too small. Prompt medical intervention, often including Caesarean section, permits a delivery safe for both mother and child. But thousands of times each year across the country, birthing women receive no such aid and their labour is a futile agony lasting between three and five days, with uterine contractions constantly forcing the baby, usually head first, against unyielding pelvic bone.
The unremitting pressure usually kills the child and prevents blood supply to the soft tissues of the vagina and other organs trapped between the baby’s skull and her pelvis. Eventually these tissues also die, forming one or more fistulas and the baby’s head softens sufficiently for the stillborn child to pass from her body. Should she survive, the mother soon finds urine, faeces or both leaking unstoppably from her vagina.
In about a fifth of cases, the woman also suffers nerve injury that can cause a condition called footdrop, which prevents normal walking. Constant contact with urine or faeces irritates and infects her skin and other tissues. Her kidneys, bladder, or other nearby organs may also be damaged.
Her menstrual periods may stop, rendering her infertile temporarily or for a long while, according to Bidemi Odukale, a gynecologist. Despite claims by the government that the VVF scourge was under control, recent findings reveal that several girls and women in the country, particularly in the rural areas, remain untreated. The United States Agency for International Development (USAID) recently disclosed that many girls and women are badly affected by the disease in Nigeria, with Ebonyi State having the highest rate of over 3,000 cases.
Although there are no reliable statistics about the epidemiology of the disease, several women and girls are reportedly rendered infertile by the disease. At the backdrop of the worrisome findings looms the sad reality of 20 VVF surgeons available to handle just a minute number of the victims.
Social reconstructions of the child bride
set is supposed to be other married women, but being a mere child, most of these women will be older and not likely to be an easy social fit. Consequently, married girls straddle two worlds and frequently find that they are alone and isolated in their new marital homes. Their isolation compounds their diminished access to information and services, making them not easily reached by conventional mechanisms such as youth centers or peer education.
The Federal Government has attempted to outlaw child marriage. In 2003, it passed the Child Rights Act, prohibiting marriage under the age of 18. But to correct the anomaly, Janet Essiet, a Kano-based lawyer and ‘women’s rights activist,’ suggests more government interventions at the grassroots.
The government also needs to cooperate with non-governmental organisations (NGOs), argued Zulaykha Habib, a guidance counsellor and owner of Muslim Sisters Development Foundation. “Efforts should be geared towards sensitising parents on the need to delay their daughters’ marriage and instead pursue their educational and psychosocial development,” she advised.
But as the government and other stakeholders return to the drawing board, they will do well to include severely damaged and disillusioned divorcees and former child brides like Amina and Maitara in their loop of schemes.
“Leaving such kids to their devices forebodes greater doom for them and the society at large. The misery and disillusionment they feel destroys their psychology and inflicts upon them a jaded view of the entire world. They have lost hope in the society and average human’s capacity to be good. This is a horrific way to see the world, particularly for teenagers and future mothers,” argued Milda Okonedo, a psychologist.
