Let’s join hands to beat fistula shame

An obstetric fistula is a childbirth injury caused by prolonged or obstructed labour, which leaves a woman incontinent of urine or faeces or both.

Despite the condition being preventable and treatable, thousands of women in sub-Saharan Africa with the condition live in isolation and social segregation.

The women find themselves ostracised and disowned by their families and communities.

That creates a massive psycho-socio impact on the women’s quality of life and curtails their contribution to their families and communities.

Although obstetric fistula has been eliminated in the industrialised countries, it continues to afflict the most impoverished women and girls in the developing world — mainly in the rural areas, where access to healthcare is limited or non-existent.

The World Health Organisation (WHO) figures show obstetric fistula affects 50,000 to 100,000 women yearly.

In Kenya, two women get it per 100 births, resulting in 2,400 new cases annually, according to data provided by Amref.

I have interacted with many patients who have been turned into victims by the social stigma.

Esther Nairesiae (not her real name), a resident of Narok County, was married off at 15, and soon afterwards became pregnant.

After a complicated labour, Esther lost her baby during childbirth.

As she tried to come to terms with that, she discovered that she had developed obstetric fistula.

It took her 12 long years to understand what was happening to her body and a few more to get help.

During this period, a lot changed. She could not continue with her beading business. After a corrective procedure backfired, she temporarily lost the ability to bear children.

Moreover, as if putting the last nail in the coffin, her husband abandoned her.

Esther’s life changed when our team of fistula specialists identified her problem during screening at a medical camp hosted by the Beyond Zero Medical Safari in Narok late last year.

Of the 299 women screened in the county, 67 had obstetric fistula. They were operated on and discharged and linked up with a local community-based organisation to help to reintegrate them into society.

Sadly, Esther’s — to varying degrees — is the story of many women across the country.

Unskilled medical care and unrefined traditional medicine is a harsh reality for many women in rural and hard-to-reach areas. For women in communities that still practise early marriages, the burden is even heavier.

Statistics by the United Nations Children’s Fund (Unicef) indicate that levels of child marriage are highest in sub-Saharan Africa, where four in 10 girls are married off before they turn 18.

Early childbearing is a major cause of obstructed pregnancies, which can lead to obstetric fistula.

In the cases we witnessed in Narok, a majority of the women were married while quite young, some as early as 12.

We must speak up against child marriages and support campaigns geared towards eradicating the practice.

Additionally, we need to advocate better access to sexual and reproductive health services and ensure that our daughters and mothers have access to skilled professionals during pregnancy and delivery.

The capacity for fistula surgical repair services in Kenya is less than 1,000 patients a year, less than half of the estimated annual incidence.

This is an indication that the country is in dire need of medical personnel trained in the management of obstetric fistula — including prevention, repair and reintegration into society.

Indeed, collaboration and partnerships between organisations and institutions will help in the reduction of stigma associated with fistula.

A lot more can be done. The National Hospital Insurance Fund (NHIF) continues to review benefit packages to members and now reimburses surgical packages including fistula repair.

However, the premiums are still a barrier to many women and the waiting period of 60 days presents a challenge.

To end obstetric fistula, there is a need to deepen universal access to reproductive health services, eliminate gender-based social and economic inequities, promote education on human rights, especially for girls, and foster community participation (including men) in finding solutions.

For the sake of girls, families, communities and the nation, we must all answer to this call.

Dr Wala is the programme director for Health Systems Strengthening at Amref Health Africa.