Technical Consultation on Cesarean Section Safety and Quality in Low Resource Settings (English, PDF, 3345 KB) The Fistula Care Plus (FC+) project at EngenderHealth and the Maternal Health Task Force, part of the Women and Health Initiative at the Harvard T H Chan School of Public Health, co-convened a technical consultation on July 27-28, 2017 to examine issues affecting the safety and quality of Cesarean section services in low resource settings. On the first day, presenters summarized current evidence related to Cesarean section provision, including an assessment of global trends, flashpoints that affect safety and quality, and country-level insights. These presentations demonstrated that Cesarean section services are often provided in settings where minimum standards for clinical decision-making, surgical safety, and counseling and consent cannot be attained due to severe resource gaps. Participants from sub-Saharan Africa and South Asia provided examples of the effects of gaps in workforce, infrastructure, and quality assurance (QA) on service delivery. While the focus of the meeting was not on Cesarean section rates, presentations clearly demonstrated that both underuse and overuse are problems with significant implications for maternal and newborn health – and that “too much” and “too little” often coexist in the same country and sometimes even the same facility. The discussion also highlighted important gaps in knowledge, such as the lack of evidence-based guidelines for labor monitoring and intrapartum risk assessment to facilitate appropriate decision-making for Cesarean section. On the second day, participants synthesized these findings, developing a consensus action agenda to improve Cesarean section safety and quality. Participants also identified immediate actions that the maternal health and OB-GYN communities can undertake to collaborate with the safe surgery community and disseminate the recommendations of this consultation to local, regional, and global stakeholders.
For more information and individual presentations, visit our
Cesarean Section Technical Consultation page.
Research Consultation on Catheterization after Obstructed Labor (English, PDF, 727 KB) Despite strong interest in and some recommendations for urinary catheterization in the prevention of obstetric fistula following prolonged/obstructed labor, there is no research evidence supporting its use. The Fistula Care Plus project hosted a research consultation on July 17, 2015, to discuss the relevance, parameters, and feasibility of a study to evaluate the effects of catheterization in preventing obstetric fistula and/or related outcomes in immediate postpartum women after prolonged/obstructed labor.
Technical Consultation on Fistula Measurement and Estimation (English, PDF, 270 KB)
On July 10-11, FC+ and MHTF convened epidemiologsts, demographers, fistula surgeons, midwives, and other researchers from around the world for a consultative meeting on fistula measurement and estimation. This consultative meeting took place at the Harvard School of Public Health alongside the FC+ IRAG meeting. This group’s goal was to build a consensus regarding FC+ priorities related to the measurement and estimation of the prevalence and incidence of obstetric fistula. Presenters summarized available approaches to measurement and estimation, such as household surveys, Health Management Information Systems (HMIS), and estimation models. As broad agreement on priorities emerged in plenary discussions, specific research questions and potential study designs were also identified when possible. Participants also provided a set of recommendations to guide future measurement and estimation activities.
International Research Advisory group Meeting Report (English, PDF, 3273 KB)
The Fistula Care Plus (FC+) project and the Maternal Health Task Force co-convened the first meeting of the FC+ International Research Advisory Group (IRAG) in July 2014 to examine research needs related to fistula prevention and treatment. The report below presents research priorities identified through the meeting and an FC+ research action plan, developed in consultation with USAID, as well as a summary of the topics that the FC+ project anticipates addressing through study develoment and other activities.
Urinary Catheterization for Primary and Secondary Prevention of Obstetric Fistula: A Consultative Meeting to Review and Standardize Current Guidelines and Practice (English, PDF, 1.14 MB)
This consultative meeting brought together a group of experienced Nigerian and international fistula surgeons, representatives of national and international professional nursing and midwifery associations, relevant officials from the Federal Ministry of Health, as well as national and international staff from the EngenderHealth-led Fistula Care project. The goal was to review current guidelines and practices, to discuss knowledge gaps, and to develop recommendations for standardized approaches to urinary catheterization for prevention and nonsurgical treatment of fistula. In preparation, Fistula Care conducted a review of literature pertinent to this topic and conducted an informal survey of current practices among Nigerian fistula service providers. Participants agreed on a simplified approach to catheterization for early management of fistula. The resulting recommendations will be disseminated to the Nigerian Ministry of Health and other relevant stakeholders, to facilitate the development and implementation of standardized national (and global) guidelines.
Meeting the Needs of Women with Fistula Deemed Incurable: Creating a Culture of Possibility (English, PDF, 622 KB)
In September 2011, EngenderHealth Fistula Care and the Harvard Humanitarian Initiative convened a meeting of international expert fistula practitioners to identify areas of consensus on minimum global standards for complex fistula care in low-resource settings. The report outlines programmatic and research gaps and priorities and includes specific recommendations to assist ministries of health, professional associations, and other key institutions in developing their own guidelines.
Revitalizing the Partograph: Does the Evidence Support a Global Call to Action? (English, PDF, 370 KB)
EngenderHealth’s Fistula Care Project and the Maternal Health Task Force brought together international experts in November 2011 to review evidence and make recommendations about the partograph, a decision-making tool for preventing and managing prolonged or obstructed labor. Correct use of the partograph can prevent serious complications, including ruptured uterus, obstetric fistula, and stillbirth. Yet after more than 50 years of training and investment in the partograph in low-resource settings, the partograph is used infrequently, and few health care workers understand how to complete it properly. This report explores the major health system challenges to partograph implementation and the evidence in favor of revitalizing its use, not only to manage labor effectively, but also to improve the overall quality of care offered to women and their babies during childbirth.
Annual Report Summary, Fiscal Year 2016-2017 (English, PDF, 231 KB) November 2017) This short summary of our annual report highlights the key accomplishments of the Fistula Care Plus project accomplished during the fiscal year (October 2016-September 2017).
Annual Report Summary, Fiscal Year 2015-2016 (English, PDF, 548 KB) November 2016 This short summary of our annual report highlights the key accomplishments of the Fistula Care Plus project during the fiscal year (October 2015-September 2016).
Annual Report Summary, Fiscal Year 2014-2015 (English, PDF, 598 KB) November 2015
This short summary of our annual report highlights the key accomplishments of the Fistula Care Plus project accomplished during the fiscal year (October 2014-September 2015).
Annual Report Summary, Fiscal Year 2013-2014 (English, PDF, 607 KB) November 2014
This short summary of our annual report highlights the key accomplishments of the new Fistula Care Plus project during the fiscal year (October 2013-September 2014).
Annual Report Summary, Fiscal Year 2011-2012 (English, PDF, 154 KB) November 2012
This one-page summary of our annual report highlights Fistula Care’s key accomplishments during the fiscal year (October 2011-September 2012).
Annual Report Summary, Fiscal Year 2010-2011 (English, PDF, 80 KB) November 2011
This one-page summary of our annual report highlights Fistula Care’s key accomplishments during the fiscal year (October 2010-September 2011).
Annual Report Summary, Fiscal Year 2009-2010 (English, PDF, 75 KB) November 2010
This one-page summary of our annual report highlights Fistula Care’s key accomplishments during the fiscal year (October 2009-September 2010).
Annual Report Summary, Fiscal Year 2008-2009 (English, PDF, 1.40 MB) November 2009
This 38-page summary of our Annual Report reviews Fistula Care’s global accomplishments during the fiscal year (October 2008-September 2009).
Annual Report Summary, Fiscal Year 2007-2008 (English, PDF, 905 KB) November 2008
This 30-page summary of our Annual Report reviews Fistula Care’s global accomplishments during the fiscal year (October 2007-September 2008).