The women who make it to the hospital typically come from poor families in rural areas, and have traveled a great distance. Niger's fistula problem stems from a number of factors. A 1995 study by the government of Niger found that 88 percent of women with fistula were married before 15, and 45 percent before 13. Nine percent were married at the age of 10 or 11. More than 60 percent of Nigerien births take place at home under poor hygienic conditions.
Some women experience a labor of three to five days.
It's believed a sign of weakness to cry out during childbirth, says a CARE physician, so even as a woman suffers through a difficult delivery, she won't complain. The resulting delay in seeking proper medical care can result in fistula, if not death. Each year, some 5,000 Nigerien women die while attempting to deliver their babies. They think it is a spirit or God punishing them. Having suffered fistula, and being therefore unable to bear children, women are often rejected by their husbands and shunned by others in their community.