UN champions efforts to end fistula in a generation

United Nations Secretary-General Ban Ki Moon says the persistence of fistula in some countries and regions is “an indicator of very poor access to quality maternal health services.” In his message to mark the International Day to End Obstetric Fistula, he called for efforts to end the condition within a generation. Experts categorise the condition […]

United Nations Secretary-General Ban Ki Moon says the persistence of fistula in some countries and regions is “an indicator of very poor access to quality maternal health services.”

In his message to mark the International Day to End Obstetric Fistula, he called for efforts to end the condition within a generation.

Experts categorise the condition as preventable and treatable, but at least two million women and girls, mostly poor and marginalised, still go through suffering and isolation associated with fistula, the UN said.

“To end it, we must strengthen health systems and address broader development and human rights issues affecting women and girls: poverty, gender inequality, early marriage, early childbearing, and lack of education,” Ban said.

“It pains me deeply that this preventable and treatable condition still exists in our world, mainly affecting the poorest and most marginalized women and girls, causing them even greater suffering and isolation,” said Ban, whose recently visited fistula patients at a hospital in Nouakchott, Mauritania.

 

Uncertain numbers

The exact of number living with fistula in Nigeria is uncertain, but estimates indicate some 150,000 have it, and up to 12,000 new cases arise every year, most from prolonged and obstructed labour.

Combined efforts to provide surgical repair comes in “pooled efforts” funded by nongovernment partners which brings dozens of women with fistula to any of the government-owned fistula centres around the country.

Only a handful of surgeons dedicate their work to repairing fistulas, and many women go without treatment.

Engender Health, which runs a USAID-funded project Fistula Care Plus for the treatment, prevention and rehabilitation targeting women affected by the condition, has backed a push for shift in policies to target common surgeries that are often neglected.

Common surgeries include “things as simple as hernia, appendectomy, complications of abortions, fistula—these are common surgeries that don’t get the required attention, but they can lead to death if left alone,” said Dr Habib Sadauki, country director for Engender Health.

“If you put the policy in place, eventually you will get these surgeries really addressed. There are many things that people tend to ignore but they constitute the bulk of what we do on daily basis,” said Sadauki.

“The problem we have is people don’t come to hospital on time. They come in only as a last resort, and that is not the time to address issues. It is now done as emergency when you are not ready. Surgeries done electively are much safer than surgeries done in a rush.”

 

Sticking together

Rukayya Adamu, who’s been through two repairs so far but is yet to go dry, has become a spokesperson to get women in rural areas to understand the condition can be treated.

Her husband Abubakar Ibrahim has become an ambassador, and hasn’t left her side through her two surgeries.

"I married her when she was okay and fine. Now I can’t just abandon her because she has this problem (fistula)," he said.

It is common for women with the condition to be abandoned by families, or divorced from their husbands.

Babatunde Osotimehin, Executive Director of the UN Population Fund, which leads the global Campaign to End Fistula since it was launched in 2003, emphasized that the condition almost exclusively afflicts the poorest, most vulnerable and most marginalized women and girls.

“It afflicts those who lack access to the timely, high-quality and life-saving maternal health care that they so desperately need and deserve, and that is their basic human right,” he said.