Tag: VVF

‘This marriage will kill me’

•Tragedy of Nigeria’s child brides

It is a harsh life for Nigeria’s child brides; besides the trauma of protracted labour on bodies too young to birth a child, the death of the child and severity of injuries sustained during labour, the child bride loses her role as wife and mother. This loss is nothing compared to the trauma of ostracism and betrayal she suffers by her parents and other family members, writes OLATUNJI OLOLADE, Assistant Editor

Just off the highway that leads to Kubwa, an Abuja outskirt, twilight bounds softly on the path to Lima’s spot. Lima, in skintight pants and transparent sari, sits in a corner of an open bar. Unlike the other girls, she does not loiter too close to the entrance, neither does she try so hard to gain the attention of every male patron; she tries not to be too obvious.
“I am not a common prostitute…I don’t parade myself like bad tomato,” she explains. There is something instructive in her analogy of the “bad tomato.” It puts in a nutshell, the realities that shape the life of the 17-year-old divorcee and social outcast.
Lima’s predicament began eight years ago in Danjida, Kano State. Just before she clocked10, her mother told her that she would be escorting her to a traditional family festival; the party was allegedly organised by the family’s elders for pretty young girls like Lima, as an initiation into womanhood. The nine-year-old was ecstatic; she was going to be a woman and, according to her mother, she would receive a lot of expensive gifts from her family friends and relatives.
The evening before the event, Lima and her mother departed from their Kawaje neighbourhood for a large compound in Danjida, her ancestral homeland, where they sat all night with her first cousins, distant cousins and other girls whom she could barely recognise. The girls waited expectantly and watched with admiration as their mothers chatted animatedly and danced to the drumbeats.
They were there all night but at the first streak of daylight, Lima’s paternal aunt, Aunt Sajida, emerged from the backyard to lead her to her fate. “She told me not to cry and urged me to do our family proud. She said if I did, I would get a lot of gifts and grow to become a very beautiful woman,” says Lima.
The nine-year-old followed her aunt sheepishly to the backyard. there, she was led into a dark room occupied by two women. According to her, no sooner did she enter than the women grabbed her hands and held her in a tight grip, one of them locking her legs and the other her arms. While she struggled with terror and an intense foreboding of what was to come, a third woman entered the room and lifted her wrapper. As Lima was struggling, her pant was practically torn off; then she felt excruciating pain. Blood gushed from her private part and cascaded her legs. In seconds, Lima (who clocked 10 years overnight) passed out.
By the time she woke up, she had undergone the gishiri cut (circumcision) and has thus become a woman by cultural standards. But nobody told her of the pain; after her circumcision, the women sewed up her private part without anaesthesia, thus causing her great pains and she bled continuously from the wound. Panic-stricken, her mother and aunt screamed repeatedly at the women who circumcised her and the latter ran helter-skelter to stop the bleeding.
Eventually, somebody brought some black powder and applied it on the wound, but it only caused her to smart and squirm some more. Lima bled the whole day and as she cried, her mother and aunt applied the black powder intermittently on the wound, causing her more pain. “I could not pee. Every time I tried to, I felt intense pain in my genitals,” says Lima, adding that she fell ill from the wound over a long period.
The following year, Lima was forcefully married to 76-year old Baba Ahmadu, her father’s best friend in a hastily contrived marriage ceremony. The details, she says, were unclear to her but she remembers that money changed hands between her father and her husband. The first time she had sex with her husband, there was a lot of trouble; Lima lied to him that she needed to pee and thereby fled to her parents’ house but her father ordered her brothers to return her to her husband. “My mother slapped me and issued me a stern warning not to disgrace her. Then my brothers tied my hands and flogged me with horsewhip,” she discloses.
They delivered her at the tender age of 11 to her husband, feet and hands bound and legs held firmly apart so he could consummate the marriage. Before the consummation, an elderly woman whom Lima identifies as her husband’s younger sister came in to undo the stitches sewn on her genitals after her circumcision. Lima had to go through this without any form of anaesthesia, hence she was in great pains. Then her brothers held her in position for her husband to mount her.
“I was already in great pain and I bled profusely before he mounted me. I begged my brothers to release me; I pleaded with them to stop holding me down for Baba Ahmadu but they turned deaf ears. They kept telling me to shut up and looked away. After he (her husband) finished, I saw him dip his hands into his pocket and give them (her brothers) N1,000,” recollects Lima with a sob.

The next day, her Aunt Mariam came visiting and tearfully, Lima recounted to her, her gruesome experience in the hands of her husband but to her horror, the latter patted her on the back and told her to cooperate with her husband. “She said I was no longer a child and that the more I struggled with him, the greater disgrace I bring upon our family. She said our ancestors would curse me if I did not stop disgracing our family…when I told her that my genitals bleed and hurt me badly, she said if I relax the next time my husband lies with me, the pain would stop and the wound will heal quicker,” says Lima.

But the pain never stopped nor did the wound heal quickly as her aunt assured her. Lima claims she felt violated and hurt every time her husband had sex with her and for a week, she could not stand or walk upright. “I could not sit down or walk upright because of the pain. I hated my husband more every time he slept with me. He virtually forced himself on me and he was very rough. Eventually, I became pregnant in two months,” she says.
However, due to complications from protracted labour, Lima’s baby died at birth and she suffered a severe case of obstetric fistula. At the onset of the disease – vesico vaginal fistula (VVF) or obstetric fistula – Lima’s husband abandoned her. She says: “He took me to the clinic and abandoned me there. He said I was destroying his home with urine and faeces. Then he sent my belongings to my parents. He said he was no longer interested in marrying me. He said I had brought him agony and bad luck.”
To her chagrin, her parents sent her belongings to her at the hospital. According to her, “They sent my eldest brother to give them to me with a sum of N900. He told me that I was not expected back home since I had brought shame on my family. He said my father had chased mother out of the house and spat at me.”
It took Lima two years and a month before she got cured and when she did, she departed for the Federal Capital Territory (FCT), Abuja, by the assistance of a nurse. The latter handed her over to a childhood friend who purportedly runs a food canteen in Kubwa, Abuja. With gratitude and optimism, Lima departed Kano for Abuja with her benefactress. But the truth didn’t dawn on her until she got to Abuja; there was no waitress job waiting for her at a food canteen, rather she was forced to squat in a tiny room at the back of her benefactress’ makeshift beer parlour in Kubwa. There, she survives by hawking sex for money, even as you read.
Lima says things are looking up for her; four months ago, her Madame granted her the freedom to entertain her own clients between 5 a.m. and 3.30 p.m. every day. Notwithstanding her predicament, Lima says: “I don’t fling myself at any man. I am not some cheap prostitute. I respect myself,” she says with the coolness of a sex worker who knows that patronage may be acquired by more discreet measures, like elegance and stubborn pride.

A suicide mission
A visit to Lima’s hometown heralds a pilgrimage of sort; the whereabouts of Lima’s mother and eldest brother is unknown and her father, Audu, currently grapples with old age. He suffers fecal and urinal incontinence brought about by age; he urinates and defaecates where he sleeps and his body is riddled with bedsores. None of the three wives he married after Lima’s mother stays with him. “they all deserted him as his condition worsened and it became clear that he lacks the means to cater for his household,” reveals Saidattu Mohammed, a bean and corn syrup seller who claims to be responsible for the 89-year old’s breakfast and supper every day. “Nobody pays me for what I do. I do it for God,” she claims.
Despite his predicament, the 89-year old betrays no love for Lima neither does he feel contrition for the way he treated her. His eyes widened and he got very agitated when the reporter revealed that he had spoken to Lima. Idrissu, a gangly youth, presumably in his mid-20s who identified himself as Lima’s immediate elder brother, ushered me out of their compound, muttering curses under his breath. According to my guide, any attempt to stay longer would have ended disastrously.

Five cows for a daughter
Like Lima, Hamida suffered the raw end of the deal from her husband and family. Hamida, 18, sells fruits at the Mararaba orange market in Nasarrawa. But that is her day job; at night, Hamida joins two of her friends at a popular roadside bar in Utaku, Abuja. At the back of the bar, she changes into tight-fitting blouse and skimpy skirt. Then she stands by the roadside to beckon on would-be patrons for ‘short-time’ sex or ‘till-day-break’ romp.
The 18-year-old’s journey to infamy began six years ago on a quiet afternoon in Kajuru, Kaduna State. According to her, she was just starting to heal from circumcision ritual when her mother and eldest sister, a widow, sat her down to inform her that they had accepted a marriage proposal on her behalf.
“When I protested that I was too young for marriage and that I would rather go to school, my mother told me that education is not meant for a cultured and dutiful daughter. Immediately, I rushed to ask my father why he did that. I told him he wouldn’t do that, if he truly loved me but he brought out a whip and started flogging me. He said he had accepted five cows for my hand. It was the first time my father flogged me in two years…I begged him not to marry me off, I cried that the marriage will kill me but he said I had become wayward and threatened to disown me if I failed to obey his wish,” reveals Hamida.
Eventually, she did her parent’s bidding and Hamida got married to Usman, a 65-year-old cow dealer at the age of 12. After the wedding, the newlywed relocated to Jibiya, Katsina State, where Usman sold cows. However, the matrimony was never as heavenly as Hamida’s mother assured her it would be.
“I had two senior wives and life with them was hellish. None of them had ever gotten pregnant and the fact that I got pregnant one month into my marriage made them hate me. They taunted me endlessly, claiming that I had charmed their husband and that God will deal with me…Eventually, their wishes came true; when I went into labour, my husband had travelled on a business trip, hence my senior wives invited a local midwife and abandoned me with her.
“They didn’t care that I had complications. The midwife said my waist was too tiny to birth a child and I had lost too much blood. After three days of painful labour, I was delivered in my room. I was there for about three days. I experienced serious pains and bled continuously. My baby never cried; I tried to breast feed him but he refused to feed. His breathing was barely audible. Worried by his state, the midwife prepared some herbal concoction and forced it down his throat; this caused his stomach and the left side of his chest to become distended.
“They said it was his heart that got bloated. At this point, the midwife stopped coming. When I sent a neighbour’s child to find her, they said she had travelled…Eventually my neighbours helped me to the hospital. When I got there, my son was confirmed dead. He died on the day that we were supposed to have his naming ceremony. While I cried, the doctor told me that I was very sick and they referred me for further treatment at the big hospital in Babbar Ruga (Babbar Ruga Vesico Vaginal Fistula (VVF) Centre in Katsina State). By that time, I was defaecating and urinating all over my body. The doctor and the nurses covered their noses and mouths while they attended to me.
“More painful was the fact that my husband at his arrival from his business trip, came to inform me that he was divorcing me. He accused me of killing his child and told me never to set foot in his house again. My mother came to see me in Babbar Ruga but she only came to give me two wrappers and N2,000. She said I should try to beg my husband and get back into his house. She said no one would welcome me back into my father’s house,” recollects Hamida.
After undergoing corrective surgery at Babbar Ruga, Hamida relocated to Abuja with two of her friends. Today, she survives by petty trade in fruits at daytime and a nocturnal trade in sex for money.

Customary disaster
The plight of Lima and Hamida 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 in the past 25 years, to end fistula through his direction of the Nigeria National Fistula Programme, states firmly that the backlog is 200,000 to a maximum 250,000 patients.
The incidence is estimated at 20,000 new cases a year; while 90 per cent are untreated. This implies that about 55 women are infected by VVF and 18,000 cases are untreated daily. 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 and transforms a healthy person into a leaking, reeking, “cesspit,” in the words of Lima.
Obstetric fistula results from obstructed labour, which occurs when the baby cannot pass through the mother’s birth canal because it either does not come head first or is too large for her pelvis. 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.
If Lima and Hamida’s experiences are more favourable than most, their years of destitution and social banishment are disturbingly typical. The Nation findings reveal that the majority of VVF sufferers are abandoned by their families, divorced by their husbands, and forced to fend for themselves, often by begging, menial jobs and prostitution.

Hopeful interventions
Nigeria has a long-standing history of fistula repair: Dr. Sr. Ann Ward was Consultant Obstetrician and Gynaecologist and fistula expert and trainer at St. Luke’s Hospital, Anua, Akwa Ibom State. She recently retired after a 40-year career. She also was in charge of the vesico-vaginal fistula treatment at nearby Itam. However, the acceleration of surgical interventions began with the arrival in Katsina in 1983 of Dr. Kees Waaldijk, a plastic surgeon from the Netherlands. He came primarily to repair the leprosy patients but quickly devoted his energy exclusively to fistula repair and training.
In the early 90s, the National Foundation on VVF was created with Dr. Waaldijk as the leading surgeon. With the commencement of the Campaign to End Fistula nationwide, fistula repair in Nigeria progressed in higher gear. An extra boost for advocacy as well as repair was given through an event that still is the referral activity: the organisation of the Fistula Fortnight in four Northern states in 2005.
Currently, there are approximately 20 centres providing VVF treatment on a regular basis in the country. According to Dr. Waaldijk, 11 of these centres are part of the National VVF Project. By 2008, the National VVF Project had performed a total 25,000 VVF/RVF repairs and related interventions since its inception.
The exact number of fistula repairs carried out annually in Nigeria is, however, unknown. Most VVF treatment centres collect information on the number of interventions carried out, but recording and reporting is incomplete and non-systematic. A centralised recording and reporting system is not in place either. It is, however, estimated that approximately some 2,000 to 4,000 fistula repairs are done every year.
But even as studies enumerate anatomical, matrimonial, and demographic factors that increase risk, experts emphasize that the basic reason for fistulas lies not in women’s bodies, social lives, or diet alone, but in the failure of health systems to provide the resources needed to ensure safe childbirth. Many studies lay “undue emphasis…on early marriage as the aetiology of the disease,” states Dr. Mohammed Kabir of Aminu Kano Teaching Hospital in Kano. According to him, the lack of skilled supervision, of childbirth and adequate emergency facilities are to blame.
Further findings reveal that the prevalence of obstetric fistula is embedded in a complex network of social issues, including socio-cultural perceptions of the status of women, the distribution and availability of health care resources, perceptions about the nature and importance of maternal health problems, and the social, economic and political infrastructures of affected societies.
“Three stages of delay,” according to medical experts, prevent victims from get-

ting the help they deserve. First, embarrassment, tradition, cost or misplaced optimism delays the realization that labour has gone awry. Second, distance, bad roads, or lack of a vehicle delay the journey to a clinic or hospital where the situation could probably have been salvaged. Finally, crowding, understaffing, or lack of resources may delay the needed services when the woman finally arrives at the clinic. A Caesarean section performed within the first 48 hours of labour will generally prevent fistula, although it may not save the baby.

An affliction of the poor?
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. “You hardly see the rich marrying their underage daughters off for money. Many of the victims come from poor homes and their parents marry them off at a tender age for economic gain,’’ she says.

One perception too many
Marriage historians have noted that it will take more than a couple of decades to rewrite a marital playbook that is thousands of years old. The institutions of child marriage are a remnant of medieval marital culture. Men who practise these types of antiquated marriages adamantly resist and reject contemporary notions of marriage as a partnership of equals based upon mutual love and free-will. The practices of child marriage rely upon the historical, social and cultural assumptions and beliefs that support marriage as an economic transaction, whereby a woman or girl, is merely an object for exchange between one man and another.
These practices inflict great harm upon women and girls. According to Milda Okonedo, a social psychologist, it traps young girls in relationships that deprive them of their childhood and education while making them vulnerable and at risk for abuse, disease and even death; this impact negatively on the woman they eventually become.

Social constructions of the child bride
As a married partner, her new social 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. For instance, interviews with victims reveal that they are isolated and under the control of their husbands and co-wives. 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. “Research findings persistently reveal that child marriage is perpetrated mostly among impoverished folks in the country’s rural areas. The government needs to make its presence felt at these local levels. Government could bolster its efforts by improving agricultural support and facilitating more income-generating opportunities for many families at the grassroots. If parents can adequately cater for their children’s needs, they won’t be forced to marry them off at ridiculous prices for survival,” she says.
The government also needs to cooperate with non-governmental organisations (NGOs) committed to the eradication of the problem, argues Zulaykha Habib, a guidance counsellor and owner of Muslim Sisters Development Foundation. “Efforts should be geared to sensitise parents on the need to delay their daughters’ marriage and instead pursue their educational and psychosocial development,” she advises.
Higher levels of education significantly decrease the risk of child marriage, with secondary education, especially strong in stalling age at marriage until a girl is 18 years or older. Governments and NGOs fighting against child marriage may focus on education and making parents aware of the benefits of allowing their daughters go to school. They need to know that education provides alternatives for their daughters that can lead to employment, earnings and an economic future that will benefit not only their daughters, but their family and community as well.
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 Hamida and Lima 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,” argues Okonedo.
Okonedo couldn’t be too far from the truth; a journey through Lima’s mind for instance reveals world-weariness characteristic of the aged who considers hope inconsequential after suffering through many tragic disappointments in her lifetime.
Lima hurts severely every time she remembers her first time in the dimly lit room where Aunt Mariam hushed her to sleep with promises of pleasure and folk song. Aunt Mariam had been sent in to calm her after she got restless and hysterical at the prospect of ‘lying’ with Baba Ahmadu, 76, her father’s best friend.
Aunt Mariam was convincing: venomous threats and thinly veiled lies leapt from her lips in measured cadence; the effect was frightening, it kept Lima from screaming and attempting further escape from the dark room. Although she eventually escaped, seven years on since the sad incident, she is still in the dark room.