By: Erin Anastasi, Coordinator, Campaign to End Fistula & Technical Specialist – SRH at UNFPA HQ (NY) & Ms. Kevin Nalubwama, Fistula Expert Client (Uganda) and Consultant (Operation Fistula)
No person can be free until all persons are free. Women’s rights are human rights, yet worldwide, too many women and girls are still denied their fundamental rights. The Fourth World Conference on Women (Beijing, 1995) and the International Conference on Population and Development (Cairo, 1994) represented ground-breaking advances in calling upon the international community to protect and secure women’s human rights, gender equality and the empowerment of women and girls.
As highlighted at the recent Generation Equality Forum in Paris, a quarter of a century after Beijing and ICPD, while remarkable advancements have been made, progress remains insufficient in achieving gender equality, universal human rights and the empowerment of all women and girls. And the most vulnerable pay with their bodies and their very lives. This is evidenced by the persistence of obstetric fistula among the poorest and most marginalized women and girls worldwide.1 Obstetric fistula has been virtually eliminated in wealthier nations, yet in low and middle-income settings, it is estimated that approximately half a million women and girls still suffer from this debilitating childbirth injury. This preventable, yet persistent global social injustice represents the failure to redress the underlying structural drivers that result in the “furthest behind” – including fistula survivors – continuing to be left behind. These include: poverty; socio-economic and gender inequalities; discrimination and exclusion; lack of access to health care (including midwifery, emergency obstetric and newborn care (EmONC) and sexual and reproductive health (SRH) services) and social protection systems including education; unfulfilled human rights; child marriage and early childbearing/adolescent pregnancy.
Abject poverty forced Ms. Kevin Nalubwama into child labor to pay for her school fees. Pressured into child marriage, she became pregnant as a teenager and had to drop out of school. During her second delivery, she unfortunately developed obstetric fistula and was hospitalized for one year. Her husband abandoned her and left her a single mother of two. Eventually, she managed to go back to school to become a journalist. With support from UNFPA & the Campaign to End Fistula, Kevin became a global spokesperson/ambassador for the Campaign and in her own country of Uganda, advocating for safe motherhood, fistula prevention and treatment and women’s human rights at global fora such as the ICPD+25 Summit in Nairobi (2018). Today, Kevin is studying to become a Midwife and dreams of becoming an international maternal and infant health advocate.
While fistula is a sign of society failing those women and girls most left behind, fistula survivors represent the epitome of hope. Women such as Ms. Kevin Nalubwama of Uganda embody dignity, resilience and the transformative power of (once) broken bodies with unbreakable human spirits.
Now is the time! This moment in time represents a historic opportunity. As highlighted by the UN Secretary General in his 2020 report “Intensifying efforts to end obstetric fistula within a decade”2, new data from Johns Hopkins University demonstrates significant progress and ushers in a new era in which elimination of fistula by 2030 is within our reach. But only if we act urgently, strategically and in a dramatically scaled-up manner.
As the leader of the global Campaign to End Fistula representing 100+ partner agencies in 55+ countries in Africa, Asia, the Arab Region (including Yemen) and Latin America/Caribbean, UNFPA, with partners, has enabled countless women and girls to reclaim their hope and healing, rebuild their lives and transform their futures. We call upon the global community to invest, intensify efforts and insist on ending this atrocity. Because women deserve better. And no woman deserves to endure the needless suffering that is fistula.
To end fistula, it is critical that bold new strategies and robust evidence are readily available to policymakers, program managers, health care providers and development practitioners. UNFPA/Campaign to End Fistula is proud to launch the new edition of the global UN guidance, Obstetric fistula & other forms of female genital fistula: Guiding principles for clinical management and programme development. This crucial, cutting-edge resource serves as a guiding light on the path to achieving health, gender equality, social justice and human rights for all, and to achieving the ambitious goal – and moral imperative – of ending obstetric fistula within a decade.
1 UN Resolution A/HRC/RES/39/13: “Preventable maternal mortality and morbidity and human rights in humanitarian settings”, adopted at the 39th session of the Human Rights Council in September, 2018 states that: “…violations of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health… can cause high levels of maternal morbidity, including obstetric fistula, leading to ill health and death for women and girls of childbearing age in many regions of the world, and particularly in humanitarian settings , and a dramatic and sustainable scaling up of quality treatment and health- care services, including high-quality emergency obstetric services and also of the number of trained, competent fistula surgeons and midwives, is needed to significantly reduce maternal & new-born mortality and to eradicate obstetric fistula.”
2 2020 UNSG Report: http://www.endfistula.org/publications/un-report-obstetric-fistula-2020