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IDENTIFY SOCIAL CULTURAL FACTORS CONTRIBUTING TO THE
OCCURRENCE OF VESICO VAGINAL FISTULA
Name
Walden University
2022
Socio-cultural factors
The socio-cultural circumstances in which Kenyan women find themselves function as
predisposing factors to their poor maternity conditions, hence incidence of VVF. These socio-
cultural factors are mostly responsible as the underlying behaviors and conditions that initiate
and sustain the affliction of VVF on its victims. Important socio-cultural conditions include but
are not limited to the following: early marriage, harmful traditional birth practices and poverty
and illiteracy.
Early marriage
WHO reports that in Ethiopia and Nigeria, majority of fistula patients had become pregnant
before the age of 15, and more than half had become pregnant before the age of 18 (UNFPA,
2006). Age at marriage no doubt affects pregnancy and labour complications among Kenyan
women, hence a likelihood of VVF. This therefore indicates that fistula prevalence tends to be
high for those women married at early stages often before menarche since their pelvis are not
fully developed (Wall & Karshima, 2004).
Female Genital Mutilation
A number of cultural practices also contribute to fistula formation. Amongst the Hausa in
Nigeria, gishiri, is a traditional medical practice in which it is thought that an imbalance between
salty and sweet foodstuffs can cause a film to form in the vaginal wall, leading to a number of
gynecological or obstetric complications, including infertility and obstructed labour (UNFPA
2002). In several Even though female genital cutting involves the external genitalia and no effect
to the pelvis where obstruction requiring Caesarean Section mostly occurs, there is popular belief
that female genital mutilation increases the risk of fistula formation (Browning 2010).
It is possible that female genital mutilation may cause direct trauma to the urinary tract during
the procedure. Secondly, extensive tissue loss from the vulva following infibulation may be
followed by marked fibrosis and reduction in the vaginal length.
Further, the practice is carried out under unsanitary conditions, often by removing large amounts
of vaginal or vulva tissue thus causing the vaginal outlet and birth canal to become constricted
by thick scar tissues increasing the likelihood of gynaecological and obstetric complications
including prolonged labour and fistula (UNFPA, 2006). A study by Mabeya (2004) in West
Pokot found that majority of the affected women had undergone the severe form of genital cut.
World Health Organization (WHO) also reports that FGM may explain as many as 15% of
fistula cases in some parts of Africa (WHO, 2006). Circumcised women often faced lots of
health consequences. However, the consequences rely on the type of procedure performed, the
extent of the cutting, the skill of the practitioner, the hygiene of the instruments, the environment
of the operation and more importantly, the physical condition of the girl to be circumcised
(Chalmers & Omer-Hash, 2003).
Sexual violence and Rape against women
In Sub-Saharan Africa alone, a recent review of obstetric fistula symptoms from demographic
health surveys and multiple cluster indicators surveys (MICs) showed that fistulas were also as a
result of sexual assault (Maheu- Giroux 2015). In a retrospective study of 604 consecutive
patients seeking treatment for fistula in the Democratic Republic of Congo, a few had fistula
related to sexual assault: some directly from forced penetration with foreign objects and/or gang
rapes; a few had a fistula before they were raped; and some had iatrogenic fistulas following
inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after
abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labour
(Onsrud, 2008).
In the review by Maheu-Giroux et al., (2015), the prevalence of women in DRC reporting that
their fistula was a result of sexual violence was higher, at 22%. This was the highest prevalence
of sexual-assault-related fistula, compared with an overall prevalence of 4.3%. Violent rape
especially that occurring in time of war is gender oriented. The World Wide Fistula Foundation
(WWFF) describes cases in Sierra Leone where soldiers raped women then inserted assault
weapons into their vagina and fired (WHO, 2005). The new Fistula Medical Centre in Sierra
Leone treats many women with VVF resulting from serial rape that occurred during that
country's Civil War. Rape also results in sexually transmitted infections, including HIV.
According to worldwide fistula fund tissue destruction diseases such as lymphogranuloma
venereal can be particularly virulent, eating into the genital tissues and causing fistulas which are
generally irreparable (WHO, 2005).
Beliefs and Superstitions
In Burkina Faso, few community members understood that fistula was a medical condition.
Many believed that fistula was the result of fate or divine punishment inflicted for bad behavior
(infidelity, disrespect of elders) or a curse by an offended party (Donnay & Ramsey, 2006).
These women who develop OF often suffer stigma, abandonment, loss of self-esteem, and
varying degrees of social isolation. They are considered perpetually unclean as sometimes they
are even excluded from food preparation, social events, and prayer ceremonies (Diallo, 2009).
Abortion
Another direct factor responsible for the incidence of VVF is complications of criminal abortion
(Hilton, 2003). Most criminal abortions are practiced by untrained individuals who claim to be
knowledgeable in the act. Through the use of wrong instruments, some girls have had their birth
canal unknowingly damaged (Tebeu, 2012). If not repaired on time and adequately, this may
result in VVF. They may also seek unsafe abortions from unscrupulous individuals, eventually
ending up with fistula (Tebeu, 2012).
Summary
The findings from chapter four shows that the socio-cultural circumstances in which the
respondents find themselves function as predisposing factors to their poor maternity conditions,
hence incidence of VVF. These findings agrees with (Landry et al., 2013) who said that these
socio-cultural factors are mostly responsible as the underlying behaviors and conditions that
initiate and sustain the affliction of VVF on its victims.
The study further shows that early marriage affects pregnancy and labor complications among
Kenyan women, hence a likelihood of VVF. These findings agrees with (Wall & Karshima,
2004) This therefore indicates that fistula prevalence tends to be high for those women married
at early stages often before menarche since their pelvis are not fully developed.
The result shows that beliefs and superstitions does not cause fistula. The results disagrees with
(Donnay & Ramsey, 2006) who posits many believed that fistula was the result of fate or divine
punishment inflicted for bad behavior (infidelity, disrespect of elders) or a curse by an offended
party.
The study shows that abortion is another direct factor responsible for the incidence of VVF is
complications of criminal abortion. This result agrees with (Tebeu, 2012) most criminal
abortions are practiced by untrained individuals who claim to be knowledgeable in the act.
Through the use of wrong instruments, some girls have had their birth canal unknowingly
damaged.
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