It begins with a cut. A seemingly small incision; often celebrated as a rite of passage and a symbol of purity and tradition. However, for millions of Nigerian women and girls, that single cut marks the beginning of a life-altering nightmare characterised by isolation, pain and stigma.
Female Genital Mutilation (FGM), often performed under the guise of cultural or religious practice, involves the partial or total removal of external female genitalia. Nigeria bears 10% of the global burden of FGM, with approximately 20 million women and girls affected. The severe scarring caused by FGM can lead to obstructed labour during childbirth, resulting in a Vesico-Vaginal Fistula (VVF), also called Obstetric Fistula, a term often used interchangeably with VVF but with a subtle difference. While VVF specifically refers to an abnormal connection between the bladder and the vagina, obstetric fistula encompasses a broader range of fistulas, including those that connect the vagina to other organs like the rectum.
According to a 2017 study conducted by the Population Council and UK Aid, in northern Nigeria, 9 to 18% of VVF were attributed to FGM. Among Sudanese women attending antenatal clinics who had undergone FGM, 9.2% to 14.6% developed VVF. While prolonged obstructed labour is a well-known cause of VVF, one of the most overlooked culprits is FGM.
Prevalence and consequences
Nigeria accounts for over 40% of global VVF cases, with an estimated 150,000 to 200,000 women currently living with the condition and 12,000 new cases emerging annually. Therefore, the scale of this health crisis cannot be ignored.
For the women living with VVF, life becomes a daily battle against humiliation and despair. Imagine a young girl, freshly married and full of dreams, only to find herself leaking urine uncontrollably after childbirth, a condition she neither understands nor can afford to treat. The stench becomes inescapable, prompting her family and community to cast her aside. Friends drift away, her husband abandons her, and she is left to navigate a world that sees her as cursed, unclean, and unworthy.
The psychological toll is equally brutal. Women with VVF frequently suffer from depression, anxiety, and suicidal thoughts. Once vibrant and hopeful, they are now shadows of themselves, cut off from society, devoid of economic opportunities, and mentally imprisoned by stigma. The irony is heartbreaking: one cut meant to uphold honour instead becomes a life sentence, stripping women of their dignity and humanity.
Persistence amidst policies
Despite the enactment of the Violence Against Persons Prohibition Act (VAPP) in 2015, which federally bans FGM in Nigeria and imposes penalties of up to two years in prison and fines perpetrators, the practice persists, particularly in rural areas.
Enforcement remains weak due to cultural acceptance and a lack of awareness of its detriments. Although 35 out of Nigeria's 36 states have domesticated the Act (except Kano), the VVF burden remains high, particularly in the northern part of the country. Moreover, while the National Policy and Plan of Action for eliminating FGM exists, gaps in implementation, awareness, and community buy-in hinder progress.
Similarly, the National Strategic Framework for the Elimination of Obstetric Fistula (2019-2023) outlines strategies to prevent and manage VVF. The Federal Ministry of Health have also increased the number of Fistula Centres across the country to treat, rehabilitate and be centres of excellence for research and capacity building for fistula surgeries. Yet, challenges such as inadequate health infrastructure, human resources for health, and socio-cultural barriers such as lack of education for the girl child and early marriage threaten its effectiveness.
Integrated solutions
Addressing this crisis requires a multi-faceted, community-driven approach. Awareness must focus on the younger generation, educating and empowering girls to understand their rights, bodily autonomy, and the dangers of FGM. Non-governmental organisations (NGOs), community-based groups, and health facilities must establish and sensitise on the linkage between FGM and VVF in their outreach programmes.
For youth advocates, social media presents a powerful platform to drive change. Influencers, celebrities, and grassroots organisations can collaborate to amplify survivors' voices and dispel harmful myths. Campaigns like #EndFGM have gained international attention. In Nigeria, local efforts like the #StopTheCut campaign are increasingly engaging young people in rural and urban communities. More localised efforts tailored to Nigeria's cultural contexts still need to be designed and amplified.
Survivors, especially those in rural communities, must have access to safe spaces for education, counselling, and support. Community health workers should be trained to identify early signs of VVF complications, ensuring timely intervention and referrals.
These services are available at the 18 fistula centres established across Nigeria by the Federal Ministry of Health (FMOH) through the Basic Health Care Provision Fund (BHCPF) where they receive free medical care and psychological support to aid their reintegration into society. It is crucial to raise public awareness about these services so that those in need can access the care and support available to them. In addition, the National Health Insurance Authority (NHIA) is supporting vulnerable Nigerians by covering Vesicovaginal Fistula treatment costs and using this as an entry point to enrol patients in government health insurance.
Elders and traditional leaders, as respected figures in their communities, have the power to transform societal norms. By openly condemning harmful practices, promoting safer childbirth, and ensuring that perpetrators of FGM face justice, they can become champions of change. When community leaders recognise and acknowledge the devastating link between FGM and VVF within their communities, they can lead by example, breaking the cycle of harmful traditions and fostering a new generation where every girl is protected.
Finally, the Nigerian government must move beyond policy statements to decisive action. The full enforcement of the VAPP Act across all states must be prioritised, with zero tolerance for perpetrators of FGM.
The time for silence has passed. Every moment of inaction allows another girl to be cut and another woman to be condemned to a life of suffering. Nigeria and other countries where FGM practice is prevalent must act now -- as individuals, as communities, and as a nation. The global community must break this chain of harmful traditions, amplify the voices of survivors, and ensure that no woman or girl is ever again sentenced to social, physical, economic, or mental death by a single cut.