Social work Practice with Childbirth-Injured Women in Nigeria

Nigerian social workers in health care settings have been actively involved in the treatment of women in northern Nigeria who suffer from childbirth injury during obstructed labor. The patient population studied suffers from vesicovaginal fistula (VVF), a debilitating and chronic condition whereby a woman leaks urine uncontrollably and experiences grave social consequences. Crisis intervention, social rehabilitation, fighting stigma, and discharge planning similar to the American professional model were functions of the social workers in addressing the needs of this patient population. Implications for practice and the universality of social work skills are discussed. Maternal morbidity and mortality rates are high in sub-Saharan Africa (Bledsoe & Cohen, 1993) because women who live in remote areas often give birth at home in the village; many die or sustain debilitating and chronic birth injuries when they find themselves in unrelieved, obstructed labor. Of these birth injuries, vesicovaginal fistula (VVF), a false passage between the bladder and the vagina, is one of the most frequent in the northern states of Nigeria. VVF occurs during childbirth when the baby's head is unable to pass through the bony pelvis, thus causing damage to the soft tissues of the vagina and creating a false passage (Harrison, 1985). Urinary incontinece follows. In some cases, damage to the nerve trunks along the pelvic girdle affects the lower limbs and results in paralysis. Earlier studies have pointed out the grave social consequences of VVF (Murphy, 1983; Ojanuga, 199 1). Divorce, destitution, and despondency often result from this injury. Consequently, social workers play an active role in helping these women. This article describes the efforts social workers are making to assist women with VVF and the implications for for social work practice worldwide. BACKGROUND Northern Nigeria Research for this article was done in Kaduna and Kano states in northwestern Nigeria. Kaduna State has an estimated population of 4.5 million people, 85 percent of whom live in rural areas in settlements and, hamlets of populations of about 5,000 people (Ojanuga, 1992b). Kano State is the most populous state in Nigeria, with an estimated population of 10 million inhabitants of similar demographic characteristics. State residents are predominantly Hausa by ethnic group and Muslim by religion and adhere firmly to their religious beliefs (Callaway, 1987). The majority of men engage in farming and function largely as producers and traders of agricultural raw materials, and women are commercial processors and distributors of food products. Men who are heads of household are financially responsible for providing housing and food for the household, and their wives are expected to care for their own personal needs such as soap, cosmetics, and room decorations (Simmons, 1990). Northern Nigeria has a high maternal mortality rate, with 36 to 40 maternal deaths per 1,000 live births (personal communication with C. C. Ekwempu, professor of gynecology and obstetrics, Ahmadu Bello University, January 1991) Cultural practices, religious beliefs, and adherence to traditional health practices greatly affect the lives of these women. Hausa Women Married Muslim Hausa women live in seclusion (purdah), never leaving their homes during the daylight hours. The family structure is polygamous, as Islam allows a man to have four wives. Most women spend their time in the household with their cowives. Although Hausa women do not have salaried employment, they generate income for their personal needs through "housetrade," or indoor business (for example, selling processed foods and consumer goods, hairdressing, and tailoring). The goods produced by the women are sold in the community by their children (Smith, 1954). Few rural Hausa women how women Westernstyle education. …