Restoring "Hope, healing, and dignity” for women living with fistula requires all our commitment

23 May 2017

In all the years I have worked in the development community there is not one issue that touches my heart more than the problem of obstetric fistula from Senegal to Madagascar, Democratic Republic on Congo and Chad-some of the countries I have served- all the way to Zimbabwe, the circumstances behind each and every woman’s “fistula story” is heart rending and disappointing. Heart rending because of the knowledge that suffering from fistula was an escape from death and disappointing because of the knowledge that this is a very easily preventable birth injury.

Fistula is a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed, labour without timely access to appropriate health care and emergency obstetric care.. It leaves women leaking urine, faeces or both and over time, it leads to chronic medical problems. Sufferers also endure depression, social isolation and deepening poverty. Obstetric fistula occurs mostly among young women and girls living in extreme poverty, especially those living far from medical services.  It is also more likely to afflict girls who become pregnant while still physically immature. Women and girls with fistula are unable to work, and many are abandoned by their husbands and families, and ostracized by their communities driving them further into poverty. Reconstruction surgery can usually repair a fistula. Unfortunately, women affected by this injury often do not know about treatment, cannot afford it and neither can they reach health facilities where treatment is available.

Indeed, obstetric fistula remains a huge problem, particularly in developing countries. It is estimated that more than 2 million women in Sub- Saharan Africa, Asia, the Arab region and Latin America and the Caribbean are living with this injury, and some 50,000 to 100,000 new cases develop each year.   Complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive age (15 -49 years). In Zimbabwe, the maternal Mortality Rate remains high at 651 deaths per 100 000 live births (ZDHS) which translates to about 8 women dying every day of pregnancy related complications. It is estimated that for every woman who dies due to pregnancy related causes another 20 to 50 suffer severe morbidities such as obstetric fistula, one of the most serious and tragic injuries that can occur during child birth.

As UNFPA, the problem of fistula is an issue very close to our heart. In 2003, UNFPA and its partners launched the global Campaign to End Fistula which now works in more than 50 countries to prevent, treat fistula, rehabilitate and empower survivors. Over the last 12 years, UNFPA has, globally, directly supported more than 57,000 surgical repairs for women and girls, and partner agencies have supported thousands more.

In Zimbabwe, UNFPA has been leading the Campaign to End Obstetric Fistula through a collaborative effort with partners, Women and Health Alliance International (WAHA) and the Ministry of Health and Child Care. This journey began in 2009 with support to the Ministry to conduct an obstetric fistula needs assessment to determine the magnitude of fistula in the country. Findings from this assessment revealed that fistula is a problem in the country. In 2015 UNFPA supported Ministry of Health and Child Care on a learning mission to Ethiopia resulting in the launch of obstetric fistula programme.In collaboration with WAHA, obstetric fistula repair camps are being held at Chinhoyi Provincial Hospital.. To date a total of five fistula repair camps have been conducted and over 300 women have benefitted from these fistula repair camps. In addition, a total of 12 doctors and 46 nurses have been trained in the pre and post- operative management of obstetric fistula through a mentorship programme led by our partner WAHA.

While all these efforts to repair fistula are important to restore the dignity of women what is key is putting efforts to prevent obstetric fistula.  As we commemorate the International Day to End Obsteric Fistula yet again this year, it is an important time for us to reflect on how each and everyone of our actions at home, in the community and as medical professionals is either contributing to the reduction or increase of obstetric fistula. Yes, everyone of us has an important role to play in preventing birth injuries. In the community, it begins with that decision not to marry off young girls before their bodies mature for child birth for whatever reasons, be they cultural or religious. We must all make an effort to end any practices that put young girls’ lives at risk of such injuries. Let us invest in the future of our young girls through education, for example, so that they realise their full potential. We know that many married women depend on key decision makers such as the husband and mother to make the decision on when to leave home for the hospital. Therefore at home, it begins with decision by the husband or mother in law of ensuring their wife or daughter in law arrives at the clinic or hospital in time to receive life-saving obstetric care. 

Everyone of us has an important role to play in preventing birth injuries.

In our various areas of responsibility let us ensure that once women reach health facilities they receive quality maternal health care timeously in the most humane and dignified manner. Women who develop complications during delivery should be provided emergency obstetric care. Obstetric fistula has been essentially eliminated in industrialized countries by the availability of treatment for prolonged and obstructed labour- typically caesarean sections. Many women in rural areas face challenges of living far away from health facilities. Investment in Maternity Waiting Homes that help bring women closer to health facilities is very key. Since 2012 UNFPA has worked with the Ministry of Health and Child Care to revitalise at least 120 Maternity Waiting Homes to ensure women, particularly those in rural areas, are closer to health facilities. In addition, providing family planning to women could reduce maternal disability and death by at least 20 per cent.

Another issue that requires our attention is that of rehabilitation and social reintegration of survivors of fistula. As stated earlier women and young girls who suffer from fistula are often left ostracised in their communities while others lose their source of livelihoods. A challenge still remains of how beyond the surgery we can support women with, for example, livelihoods projects that can help them reintegrate into society. We will continue looking into how we can add this missing piece of the puzzle through partnerships and collaborations.

I am confident that if we stand with the country’s poorest, most marginalized women and girls, together through our collaboration and partnerships, we can mobilize the support and commitment needed to transform the women’s lives into stories of hope, healing and eliminate the problem of obstetric fistula in Zimbabwe. 

Sincere gratitude to all our donors – the Governments of Britain, Canada, Ireland, Sweden and European Union, Swiss Agency for Development and Cooperation. - who continue to support our work as UNFPA on maternal health.

In line with this year’s theme of: “Hope, healing and Dignity for all” I would like to reaffirm UNFPA’s commitment to ensuring all women realize their full potential in life through a healthy and productive life through equitable access to sexual and reproductive health rights and services. In this endeavor, we will continue to partner with the Government of Zimbabwe and other partners to achieve this commitment.

Cheikh Tidiane Cisse is the UNFPA Country Representative in Zimbabwe. He has served in many countries that include Zimbabwe, Chad, Madagascar, Senegal, DRC and is a strong advocate for women and girls’ Sexual Reproductive Health.