Vesicovaginal Fistula (VVF) Awareness, Stigmatization and Free Medical Care in Nigeria

Abstract

Vesicovaginal fistula (VVF) remains a significant but largely preventable maternal health problem in Nigeria, particularly among women living in rural and underserved communities. This study examined awareness, stigmatization and access to free medical care for VVF in Nigeria, with emphasis on factors influencing knowledge, treatment-seeking behaviour and social reintegration. The study was anchored on the Health Belief Model (HBM), which explains how perceived susceptibility, perceived severity, perceived benefits, perceived barriers and cues to action influence health-seeking behaviour. A literature-based review approach was adopted using recent Nigerian studies, national policy documents and programme reports published between 2019 and 2026. Findings indicate that awareness remains uneven. Analysis of the 2018 Nigeria Demographic and Health Survey involving 26,585 women showed that only 52.0% had heard of vaginal fistula, while awareness varied considerably by region, education, residence, wealth status and access to information. A qualitative study involving 65 focus-group participants and 44 in-depth interviews in Ebonyi and Kano States further found widespread misconceptions about the causes, symptoms and availability of treatment, with many women seeking inappropriate care or delaying treatment. Stigmatization was also substantial. Among 183 Nigerian women receiving VVF care in Southeast Nigeria, increased health stigma was associated with reduced health disclosure and poorer psychological well-being. Evidence on treatment demonstrates that VVF is surgically treatable. UNFPA reported that free treatment reached 2,117 women and girls in Nigeria in 2021, with 92% achieving successful repair at three-month follow-up. More recently, the National Health Insurance Authority's Fistula Free Programme had treated more than 1,629 women by January 2025 across 18 accredited facilities, with treatment, transportation, feeding, follow-up and insurance enrolment included. However, 2026 evidence from 5,496 women reporting fistula symptoms in the 2024 Nigeria Demographic and Health Survey showed a substantial treatment cascade gap: only 65.0% sought treatment, 3.3% received surgical repair and 6.9% achieved resolution. Geographic access was the only significant mediating barrier to treatment-seeking. The study concludes that improving VVF outcomes in Nigeria requires integrated awareness campaigns, stigma reduction, early referral, decentralization of treatment services and sustained government-supported free medical care.