Charting the Way to a Fistula-free Generation

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By: Dr. Joseph Ruminjo, EngenderHealth; Pamela Barnes, EngenderHealth

This post was originally posted on the Huffington Post’s Global Motherhood blog.

We are thrilled to be in Uganda to recognize the achievements of EngenderHealth’s Fistula Care project, the largest U.S. government-funded initiative to treat and prevent obstetric fistula in more than 10 countries throughout Africa and Asia. We are here with our incredible partners — government officials, representatives of nongovernmental organizations, doctors, community health providers and hospital administrators — to share lessons learned and chart the way forward toward achieving a fistula-free generation.

This is a milestone not just for the project, but more importantly for the maternal health field. With our partners, we have supported more than 26,000 fistula repair surgeries and trained 33,500 surgeons, nurses and community health workers to prevent and treat fistula. We have also advocated for policy changes to tackle root causes of fistula, including family planning, early marriage and poor access to emergency obstetric care.

In our ongoing efforts, we’ve identified and implemented practices that have significantly improved outcomes for women with fistula. Given the complexity of fistula surgery, ensuring standard prevention and surgical practices and care will have a huge impact on women’s health. Fistula Care embarked on extensive research and training to identify practices that would help improve standard treatment and care, which will ultimately improve the quality of care and outcomes for women with fistula.

We’ve learned more about who fistula affects and how to better support women. Unlike what the media portrays, not every woman living with fistula is a destitute young woman, abandoned by her loved ones and marginalized from society. Rather, a recent study published in Global Public Health: An International Journal for Research, Policy and Practice indicates that fistula affects women across all age-groups, educational backgrounds and relationship levels. Characteristics of women who seek fistula repair vary from country to country. For instance, not all husbands and families abandon women with fistula, and only a small minority of women with fistula live alone. Understanding exactly who is affected by fistula based on where they live and their individual experiences in seeking treatment — rather than relying on generalizations — will help us better support women in their recovery and reintegration into society.

Despite these differences, one constant remains: Not all women living with fistula are victims. For years, EngenderHealth has worked with immensely strong women living with fistula who have refused to yield to their debilitating condition and have gone to great lengths to seek out treatment, including crossing national borders to find someone with the reputation to help them with their condition. Equally courageous women have survived fistula and have devoted their lives to ensuring that members of the next generation have planned births, healthy pregnancies and safe deliveries. If we’ve learned anything from their strength, it’s that the key to prevention lies in empowerment.

Access to quality maternal health programs is critical to achieving a fistula-free generation. We know that fistula is not selective — it can affect any girl or woman giving birth if she experiences obstructed labor and doesn’t have access to timely, quality emergency obstetric care. The reality is that girls and women who have increased access to family planning and skilled birth attendance have a greater chance of preventing fistula from happening in the first place.

We have the solutions at hand: We must continue working at both policy and program levels to upgrade and increase access to emergency obstetric care, train more surgeons and health care professionals and partner with communities to raise awareness of the need for skilled care at delivery and family planning. We know what it will take to achieve a fistula-free generation, and together we must accelerate momentum to make fistula as rare in Africa and Asia as it is today in the United States.

Pamela Barnes is the President and CEO of EngenderHealth.You can follow her on Twitter at @pamwbarnes

Dr. Joseph Ruminjo is a consultant obstetrician-gynecologist and Clinical Director of EngenderHealth’s Fistula Care Project.

Join the conversation live in Uganda on Twitter at #fistulafree.

Stay tuned for more updates from our colleagues participating in the meeting in Uganda this week. We’ll be posting their reactions to the meeting here.