Combating Obstetric Fistula through global initiatives, local heroes

By Abujah Racheal, News Agency of Nigeria (NAN)

Obstetric fistula, a global affliction disproportionately affecting women in low-resource countries, continues to devastate lives.

According to experts, obstetric fistula, is an abnormal opening between a woman’s genital tract and her urinary tract or rectum.

Primarily striking young, impoverished women lacking adequate medical care, the condition manifests in urinary or faecal incontinence, leading to social isolation and rejection.

The World Health Organisation estimates that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.

While surgical intervention offers hope, research on outcomes remain limited, underscoring the imperative for preventive measures.

For over two decades, the United Nations Population Fund (UNFPA) has spearheaded the Global Campaign to End Fistula, operating in 55 countries with a holistic approach encompassing prevention, treatment, survivor reintegration, and advocacy.

Grounded in human rights principles, this initiative strives for equality, participation, and accountability.

According to the National Institutes of Health, in sub-regional analysis, West Africa had the highest successful surgical closure rate for obstetric fistula, with 91.74 per cent of the global total, while Central Africa recorded the lowest rate at 84.04 per cent.

Also, the successful surgical closure rate of Vesicovaginal Fistula (VVF) with unknown urinary incontinence status varied widely across African countries, ranging from 63 per cent in Eretria to 100 per cent in Liberia and Nigeria.

The pooled estimated rate of successful closure of VVF with unknown incontinence status from 55 articles is 86.31 per cent.

In spite of the progress, achieving the 2030 goal of eliminating fistula requires intensified efforts.

In Tanzania, obstetric fistula remains a poignant reality, with approximately 3,000 cases annually.

Yet, stories of resilience emerge, exemplified by survivors like Mrs Anastasia Beni-Majasho, at 29 years old, developed obstetric fistula during a difficult childbirth after losing her second child.

Beni-Majasho faced social stigma and isolation until she discovered the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), providing holistic fistula treatment and support services.

Through surgical intervention, counseling, rehabilitation, and skills training, she embarked on a journey toward recovery and empowerment, benefiting from a supportive community of healthcare providers and fellow survivors.

Another inspiring story is that of Mrs Sofia Mwema, who sought solace at CCBRT after enduring 19 years of social isolation due to obstetric fistula.

Through comprehensive care, including surgery, counseling, and skills training, she regained physical health, confidence, and purpose, becoming a beacon of hope for her community.

For 70-year-old “Mama”, who shares her daily struggle to overcome the suffering caused by injuries sustained during childbirth, the determination is to ensure that no woman is left behind.

She recalled how the only child she gave birth to caused her severe injuries, resulting in incontinence, and later died.

This left her ostracised by her husband and community. However, surgery provided the only cure that restored her confidence from obstetric fistula.

CCBRT, led by CEO Dr Brenda Msangi, has transitioned from a community-focused NGO to Tanzania’s leading provider of disability and rehabilitation services.

Msangi emphasised safe childbirth as a fundamental right, ensuring CCBRT facilities were accessible and staff are trained to offer compassionate care to all expectant mothers.

Highlighting the distressing statistic of an 85 per cent fatality rate for babies during obstructed labour, she said that CCBRT offered hope by providing free childbirth services to alleviate anxieties.

She dispelled misconceptions surrounding fistula, adding that it is a medical condition, not a curse.

“Through a comprehensive approach including eye surgery, prosthetic limbs, and physical therapy, CCBRT transforms lives daily.

“The organisation addresses prevalent myths, financial constraints, and cultural barriers hindering women from seeking help for fistula, offering education, free surgery, and transportation assistance through a network of community ambassadors,” she said.

She commended Tanzania’s progress in maternal healthcare under President Samia Hassan’s leadership, highlighting CCBRT’s community outreach programs like the Mabinti Centre, empowering fistula survivors through skill-building and economic independence.

With continued support, she believed these programmes could significantly enhance the lives of women across Tanzania.

Tanzania’s approach to combating obstetric fistula offers valuable lessons for other countries.

The emphasis on community-based rehabilitation and holistic care, as demonstrated by CCBRT, highlights the importance of addressing not only the medical aspects of fistula but also the social, psychological, and economic dimensions.

By providing comprehensive support services, including counseling, skills training, and reintegration support, Tanzania demonstrates how a multi-dimensional approach can enhance the well-being and dignity of fistula survivors.

Furthermore, Tanzania’s commitment to promoting safe childbirth as a human right, as advocated by Msangi, underscores the importance of ensuring universal access to quality maternal and obstetric care.

By prioritising accessibility, equity, and compassion in healthcare delivery, Tanzania sets a precedent for other countries striving to improve maternal health outcomes and prevent obstetric fistula.

Meanwhile, Nigeria grapples with a significant burden of obstetric fistula, with an estimated 400,000 to 800,000 affected women and inadequate surgical capacity exacerbating the backlog of untreated cases.

According to Dr Fatima Ahmed, an obstetrician, addressing this challenge demands a comprehensive response, encompassing political commitment, evidence-based policies, preventive initiatives, and robust healthcare infrastructure,

Ahmed said that Nigeria’s efforts to end obstetric fistula included implementing a National Strategic Framework for elimination, capacity building for healthcare workers, community outreach programmes , collaboration with NGOs, and legislation and policy reforms targeting factors contributing to fistula.

She said that by investing in healthcare infrastructure, engaging communities, and advocating for women’s rights, Nigeria aimed to prevent fistula and improve maternal healthcare nationwide.

She added that other African countries can learn from Nigeria’s experiences by adopting national strategies tailored to their contexts, investing in healthcare infrastructure, and engaging communities through awareness campaigns.

The obstetrician recommended educational programmes, enacting and enforcing laws and policies to protect women’s rights, and fostering partnerships and collaboration between governments, NGOs, and international agencies.

In spite of the notable rate of successful closure of obstetric fistula in Africa, a considerable proportion of women still experience residual or persistent incontinence.

Experts say successful surgical closure rate of combined VVF and RVF still falls significantly below the recommendation set by WHO.

Dr Na’ima Idris, a Kano-based reproductive health expert, said that implementing a comprehensive package of fistula care through a dedicated fistula facility or a mobile surgical outreach programmes , holds promise in addressing this issue on the continent .

Addressing this challenge will help Africa in its efforts to achieve Sustainable Development Goal No 3 which entails ensuring healthy lives and promoting well-being for all.

Idris said that ensuring increased access to timely and high-quality fistula treatment, along with comprehensive post-operative care, was essential for achieving high success rates and reducing residual incontinence among women with fistulas in Africa.

As the world unites in the fight against obstetric fistula, the voices of survivors like Mama, whose resilience embodies hope, echo with resilience and determination.

Through collective action, advocacy, and investment in healthcare systems, the African continent can pave the way for a future where no woman suffers the indignity of obstetric fistula, where every childbirth is safe, and where every woman receives the care and support she deserves. (NANFeatures)

**If used please credit the writer and News Agency of Nigeria.