The devastating effects of obstetric fistula (OF) can be prevented and treated with timely, high quality medical care. Unfortunately, many of the barriers to maternal health care access—such as distance, cost, quality of care and socioeconomic or cultural factors—are also challenges for women seeking care for OF. Additionally, some women are unaware that treatment is available, while others face stigma, shame, depression and anxiety, which can further impede treatment. Interventions to address OF can restore hope, healing and dignity for all—this year’s theme for International Day to End Obstetric Fistula.
A recent systematic review identified 12 studies evaluating OF interventions in Ethiopia, Kenya, Nigeria, Somalia, Tanzania and Uganda. The review included innovative demand- and supply-side interventions addressing different types of barriers to OF care.
Using mobile phones to make fistula repair a reality
In Kenya, programmers have used M-PESA, a mobile phone-based money transferring service, in combination with a public education campaign to facilitate transportation for women seeking free fistula repair and follow-up visits. During its first month of implementation, the intervention increased the number of women seeking fistula repair from 15 to 40 at the Freedom From Fistula Foundation (FFF) at Jamaa Mission Hospital in Nairobi. Between July 2009 and November 2010, FFF funded fistula repair for 230 women, citing M-PESA as “making treatment a reality for many women who otherwise would still be living with fistula.”
Similarly, CCBRT (Comprehensive Community Based Rehabilitation in Tanzania), represented in the United States by Kupona Foundation, established a mobile outreach program, “Transport MY Patient.” Partnering with health worker “ambassadors” to identify women in need of fistula repair in the Dar es Salaam area, this program used M-PESA to fund women’s transport costs. In 2010, the program saw a 65% increase in the number of women seeking fistula repair from the previous year. In 2011, the number of OF care referrals increased by nearly a third compared to 2010.
Leveraging the media to promote fistula care
Public education and media campaigns have aimed to reduce the stigma around OF, strengthen prevention efforts and improve access to treatment. In northern Nigeria, as part of the global Campaign to End Fistula, the media and community leaders were engaged to raise awareness about fistula. During Fistula Fortnight, a two-week mass OF treatment project held in 2005 to address the high number of untreated fistula cases, a team from the United Nations Populations Fund and site coordinators liaised with the media to promote the event and enhance community knowledge of OF. This garnered international media attention related to fistula prevention and treatment, as well as broader maternal health quality of care issues.
Also in northern Nigeria, Population Media Center aired a 70-episode research-based radio serial drama called Gugar Goge (“Tell It To Me Straight”), which told the story of a 12-year-old girl who developed fistula due to obstructed labor. An evaluation of the intervention found that over 90% of the population in Kano and Kaduna states reported hearing at least one episode, and 54% of clients seeking fistula services were motivated to do so because they listened to the series.
Partnering with communities and peers
In 2015, USAID’s Fistula Program trained nearly 800 community health volunteers—including women who had undergone fistula repair, community members and local religious leaders—across six countries to improve fistula education and facilitate women’s reintegration post-treatment. The program’s fistula prevention and care messages reached over 400,000 people.
Supported by the Fistula Care project from 2006-2012, pre-repair centers in Ethiopia’s Amhara region identified and screened potential fistula repair clients and provided pre-surgery care and rehabilitation. The centers were staffed with fistula mentors who led sessions on health education for clients and capacity-building for health providers. Along with the pre-repair centers, a community outreach program disseminated information about OF prevention, treatment and services in churches, mosques, markets, schools and homes.
In Nigeria, Fistula Care formed a clinical peer-support network to facilitate women’s access to repair services and standardize and strengthen services across facilities. This collaborative, “pooled-effort” approach allowed newly-trained surgeons to gain experience and provided high quality repairs for women with complex fistula cases.
Raising awareness about OF prevention and treatment as well as the suffering so many women endure is critical to reducing the global burden of fistula.
“Nearly everyone we speak to about fistula looks at us quizzically and says something along the lines of, ‘I’ve never heard of that—sounds terrible.’ I wish there were more misconceptions that we could correct, but we must first get the world to know what obstetric fistula is.” (Seth Cochran, Founder and CEO, Operation Fistula)
Ending fistula in all forms—including obstetric, traumatic and iatrogenic—requires addressing underlying systemic issues while taking definitive steps to improve global high quality maternal health care access.
“The time has come for the global health community to adopt a narrow, deep surgical ecosystems strengthening platform for fistula eradication as opposed to the current broad, cross-sector women’s empowerment platform.” (Lauri Romanzi, Project Director of Fistula Care Plus)