Obstetric Fistula: Restoring women’s dignity has never been more important Tendai Chimana can smile again after she had her fistula repaired under the End Fistula campaign

Rumbidzayi Zinyuke Health Buzz

When a woman gets pregnant in Africa, it is a cause for celebration. We celebrate the life she is carrying so when she finally gives birth, we say “congratulations makorokoto/amhlophe”.

Congratulating a woman who has given birth is an acknowledgement that not all women who go into labour come out of it alive or with the child.

Unfortunately, some women do not always get to hear these words.

Millions of women across the world die during child birth, some from conditions that can be prevented.

And for every maternal death, it is estimated that an additional 20 to 30 women develop serious pregnancy-related complications.

Among all maternal morbidities, obstetric fistula is one of the most devastating.

This is caused by injury during childbirth, resulting in an abnormal opening between the genital tract and the bladder or rectum. It leads to continuous urinary or faecal incontinence (the women are left leaking urine, faeces or both).

Worldwide, an estimated two to three million women have obstetric fistula, almost exclusively in sub-Saharan Africa and South Asia.

The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour.

Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems.

In Zimbabwe, there is a high number of women who suffer from this condition with at least 30 affected women seeking assistance each day.

One such woman is 32-year-old Tendai Chimana from Birchenough Bridge, Manicaland who suffered from obstetric fistula for 12 years after her second pregnancy.

Unfortunately for her, her first child died after a few days and the second baby was stillborn. After the stillbirth, she started leaking urine all the time.

According to the United Nations Population Fund (UNFPA) in about 90 percent of cases, the baby does not survive, which means the mother has to deal with the devastating internal injuries on top of her loss.

A previously jovial and active Tendai suddenly retreated into her shell as she could no longer interact with her family or the community as before.

“I tried to get help but at the end I could not afford the US$2 500 that was needed for a corrective surgery and I gave up,” said Tendai.

“I told my relatives that I would just have to live with this condition. But this was the worst time of my life.

“I could not go to any community gatherings be it funerals or even at family gatherings. I would ask myself if people could tell that I was smelling of urine so I was never comfortable around people.”

She only got help after the village health workers from her community received training and got to know about a camp that was being offered to repair obstetric fistulas for women at Chinhoyi Provincial Hospital.

Tendai’s fistula was repaired for free through the UNFPA and Ministry of Health and Child Care campaign to End Obstetric Fistula under the Health Development Fund, which was supported by the Governments of Britain, Ireland, Sweden and the European Union.

Through the campaign, repair camps were done periodically at Chinhoyi Provincial Hospital which was set up as a centre of excellence for fistula repair

While Tendai has completely healed, she, however, has not been able to have a child. She remains hopeful that she will one day conceive and hold her own child.

In the meantime, she has assisted other women who suffer from the same condition to get the necessary help.

But many others remain untreated and living in shame. Obstetric fistula has been virtually eliminated in industrialised countries through the availability of timely, high-quality medical treatment for prolonged and obstructed labour.

But for the marginalised and under privileged women and girls, especially those living far from medical services, fistula remains a major cause for concern.

The major drivers of fistula are child-bearing in adolescent girls before the pelvis is fully developed, as well as twin pregnancy, breech position of the baby, malnutrition, small stature and generally poor health conditions are among the physiological factors contributing to obstructed labour.

However, any woman may experience obstructed labour, including older women who have already had babies.

If left untreated, obstetric fistula causes chronic incontinence and can lead to a range of other physical ailments, including frequent infections, kidney disease, painful sores and infertility.

The physical injuries combined with misperceptions about the cause of fistula often results in stigma and discrimination, leading to social isolation and psychological harm.

Those affected suffer from depression and suicidal thoughts and other mental health issues. With no opportunities to eke out a living, the women are driven deeper into poverty and vulnerability.

Up to 95 percent of fistulas can be corrected through surgery.

Through its assistance to countries and the campaign to End Fistula, UNFPA has supported more than 700 life-changing repairs in Zimbabwe since 2015.

More still needs to be done.

Before women reach treatment stage, there is need to place focus on prevention of obstetric fistula.

Access to family planning, skilled birth attendants and emergency obstetric care should be prioritised.

There is also need to address societal factors that contribute to fistula such as early marriage and pregnancy.

UNFPA says ensuring skilled birth care at all births and providing timely and high quality emergency obstetric care for all women and girls who develop complications during delivery would make this tragic condition as rare in developing countries as it is in the industrialised world.

Zimbabwe is implementing strategies that work towards a better access to maternal healthcare and other interventions needed to end fistula.

With the closing out of the Health Development Fund in 2022, under which the End Fistula campaign was being funded, there is great hope that the successor fund, the Health Resilience Fund (HRF) will continue the fight.

The HRF, is a pooled health fund with financial commitments of about US$90 million over the next three years which is being rolled out with financing from the European Union, the Governments of Ireland, the United Kingdom, and Gavi, the Vaccine Alliance.

UNICEF, UNFPA and WHO are the technical partners of the Fund which is expected to contribute to the improvement of health care for vulnerable mothers, new-borns, children and adolescents in Zimbabwe.

The Health Resilience Fund will build on the gains of the Health Development Fund and address the remaining challenges to ensure access to maternal, child and sexual and reproductive health and nutrition services, and to strengthen the health system’s resilience to shocks.

Vice President and Minister of Health and Child Care Dr Constantino Chiwenga has expressed Government’s commitment to supporting the implementation of the Health Resilience Fund programme in the same way it had supported its predecessor programmes.

“The funds pledged will be used efficiently and effectively as the Government remains focused on achieving the highest standard of health care and quality of life, possible for all its citizens,” he said.

This, coupled with community awareness, will definitely make Ending Fistula by 2030 a possibility.

Communities should also be aware that delaying the age of first pregnancy, stopping harmful traditional practices and timely access to obstetric care will help to end fistula.

Preventing and managing obstetric fistula will also contribute to the Sustainable Development Goal 3 of improving maternal health.

It remains important to restore the dignity of all these women as soon as possible.

No woman should suffer from such a condition while bringing forth new life.

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