Archives of Gynecology and Obstetrics

, Volume 284, Issue 2, pp 371–378 | Cite as

The psychosocial impact of vesico-vaginal fistula in Niger

  • Amina P. AlioEmail author
  • Laura Merrell
  • Kimberlee Roxburgh
  • Heather B. Clayton
  • Phillip J. Marty
  • Linda Bomboka
  • Salamatou Traoré
  • Hamisu M. Salihu
General Gynecology



To explore the psycho-social impact of vesico-vaginal fistula (VVF) on women in Niger.

Study design

We conducted a qualitative study on 21 women in convalescence at the DIMOL Reproductive Health Center in Niamey, Niger, in 2008 and 2009. The women had undergone 1–3 fistula repair operations and all had stillborn infants.


Women reported many psychological consequences of VVF including depression, feelings of shame, and loneliness. Others reported feeling devalued as a woman and wanting to end their lives. Social consequences of fistula reported by these women included rejection from society, isolation, rejection from husband and/or divorce. Almost half of the women reported of having lost their social network and support as a result of the fistula. Women with VVF were deemed unworthy, and their illness was often attributed to some fault of their own.


Our findings support the notion that socio-economic factors, though they certainly contribute to obstetric fistula, are not the primary reason for fistula, particularly in Niger. Fistula is a direct result of lack of access to skilled birth attendants and emergency obstetric care.


Vesico-vaginal fistula Niger Psycho-social consequences of fistula Obstetric fistula 



We are immensely grateful to the staff of DIMOL for their tremendous contribution and to all the women of the Center for sharing their stories and making this study possible.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J et al (2006) Maternal health in poor countries: the broader context and a call for action. Lancet 368:1535–1541PubMedCrossRefGoogle Scholar
  2. 2.
    Jones D (2007) Living testimony: obstetric fistula and inequities in maternal health. Campaign to end fistula, family care international, United Nations population fund, New York. Accessed 28 Dec 2009
  3. 3.
    Wall L (2006) Obstetric vesicovaginal fistula as an international public-health problem. Lancet 368(9542):1201–1209PubMedCrossRefGoogle Scholar
  4. 4.
    Lewis G, Bernis L D (2006) Obstetric fistula: guiding principles for clinical management and programme development. World Health Organization integrated management of pregnancy and childbirth, Geneva. Accessed 12 Jan 2010
  5. 5.
    Semere L, Nour N (2008) Obstetric fistula: living with incontinence and shame. Obstet Gynecol 1(4):193–197Google Scholar
  6. 6.
    Murk W (2009) Experiences with obstetric fistula in rural Uganda. Yale J Biol Med 82:79–82PubMedGoogle Scholar
  7. 7.
    World Health Organization (2006) Country profile of Niger. Accessed 13 Sep 2009
  8. 8.
    World Health Organization (2008) Eliminating female genital mutilation: an interagency statement. Accessed 5 Jan 2010
  9. 9.
    Meyer L, Ascher-Walsh C, Norman R, Idrissa A, Herbert H, Kimso O, Wilkinson J (2007) Commonalities among women who experienced vesicovaginal fistulae as a result of obstetric trauma in Niger: Results from a survey given at the National Hospital Fistula Center, Niamey, Niger. Am J Obstet Gyn 197:90e1–90e4CrossRefGoogle Scholar
  10. 10.
    Ahmed S, Holtz S (2007) Social and economic consequences of obstetric fistula: life changed forever? Int J Gynecol Obstet 99:s10–s15CrossRefGoogle Scholar
  11. 11.
    Kabir M, Abubaker I, Umar U (2004) Medico-social problems of patients with vesico-vaginal fistula in Murtala Mohammed Specialist Hospital, Kanno. Ann Afr Med 2(2):54–57Google Scholar
  12. 12.
    Higgins JA, Hirsch JS, Trussell J (2008) Pleasure, prophylaxis and procreation: a qualitative analysis of intermittent contraceptive use and unintended pregnancy. Perspect Sex Reprod Health 40(3):130–137PubMedCrossRefGoogle Scholar
  13. 13.
    McLeroy KR, Bibeau D, Steckler A, Glanz K (1988) An ecological perspective on health promotion programs. Health Educ Q 15:351–377PubMedGoogle Scholar
  14. 14.
    Bernard HR (2000) Research Methods in Anthropology: Qualitative and Quantitative Approaches, 2nd Ed edn. Sage Publications, LondonGoogle Scholar
  15. 15.
    Chen LC, Huq E, D’Souza S (1981) Sex bias in the family allocation of food, health care in rural Bangladesh. Popul Dev Rev 7(1):55–70CrossRefGoogle Scholar
  16. 16.
    Hollos M, Larsen U (2008) Motherhood in sub-Saharan Africa: the social consequences of infertility in an urban population in northern Tanzania. Cult Health Sex 10(2):159–173PubMedCrossRefGoogle Scholar
  17. 17.
    Morgan MA (2007) Another view of “humanitarian ventures”, “fistula tourism”. Int Urogynecol J 18:705–707CrossRefGoogle Scholar
  18. 18.
    Ndiaye P, Amoul KG, Abdoulave I, Dagne CM, Tal-Dia A (2009) Epidemiology of women suffering from obstetric fistula in Niger. Med Trop 69(1):61–65Google Scholar
  19. 19.
    Anonymous (1995) Fistula—a disaster for teenage mothers. AIDS Anal Afr 5(5):3Google Scholar
  20. 20.
    Miller S, Lester F, Webster M, Cowan B (2005) Obstetric fistula: a preventable tragedy. J Midwifery Womens Health 50(4):286–294PubMedCrossRefGoogle Scholar
  21. 21.
    Gharoro EP, Agholor KN (2009) Aspects of psychosocial problems of patients with vesico-vaginal fistula. J Obstet Gynaecol 29(7):644–647PubMedCrossRefGoogle Scholar
  22. 22.
    Nathan LM, Rochat CH, Grigorescu B, Banks E (2009) Obstetric fistulae in West Africa: patient perspectives. Am J Obstet Gynecol 200(5):e40–e42PubMedCrossRefGoogle Scholar
  23. 23.
    Nafiou I, Idrissa A, Ghaïchatou AK, Roenneburg ML, Wheeless CR, Genadry RR (2007) Obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. Int J Gynecol Obstet 99:S71–S74CrossRefGoogle Scholar
  24. 24.
    Campaign to end fistula monitoring and evaluation working group (2005) Meeting report: developing a results framework for the campaign Niamey, Niger. 21–22 April 2005. Accessed 5 Nov 2009

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Amina P. Alio
    • 1
    Email author
  • Laura Merrell
    • 1
  • Kimberlee Roxburgh
    • 1
  • Heather B. Clayton
    • 1
  • Phillip J. Marty
    • 2
  • Linda Bomboka
    • 1
  • Salamatou Traoré
    • 3
  • Hamisu M. Salihu
    • 4
    • 5
  1. 1.Department of Community and Family Health, College of Public HealthUniversity of South FloridaTampaUSA
  2. 2.Chiles Center for Healthy Mothers and BabiesUniversity of South FloridaTampaUSA
  3. 3.DIMOL, Santé de la Reproduction pour une Maternité Sans RisqueNiameyNiger
  4. 4.Department of Epidemiology and BiostatisticsUniversity of South FloridaTampaUSA
  5. 5.Department of Obstetrics and GynecologyUniversity of South FloridaTampaUSA

Personalised recommendations