Obstetric fistula: everyone in action to eradicate it

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Extract from the article: Obstetric fistula is a perforation between the vagina and the bladder and/or rectum, caused by prolonged or obstructed labor without access to prompt, quality medical treatment. Many factors contribute to obstetric fistula, including poverty, lack of

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Obstetric fistula is a perforation between the vagina and the bladder and/or rectum, caused by prolonged or obstructed labor without access to prompt, quality medical treatment. Many factors contribute to obstetric fistula, including poverty, lack of access to quality reproductive health care, early pregnancy, child and forced marriage, violence against young women and girls, socio-cultural barriers, marginalization, illiteracy and inequality between men and women. It is imperative to give priority to preventing this scourge, which has serious medical, social, psychological and economic consequences for the most vulnerable girls and women.

Obstetric fistula remains a potentially fatal health and human rights problem in several countries, including Côte d'Ivoire, Benin, Burkina Faso, Togo and Gambia. It leads to leakage of urine or faeces through the vagina.  Obstetric fistula is a grave injustice that deprives women of their health, dignity and opportunities.

The prevalence of obstetric fistula is highest among the most marginalized women living in remote areas with limited access to quality reproductive health services and insufficient knowledge of the risks of pregnancy and childbirth. Early motherhood further increases the risk of complications, leading to high levels of obstetric fistula and other maternal morbidities, including maternal mortality. Tragically, around 90% of women who develop fistula deliver stillborn babies, compounding the emotional toll and grief these women endure.

In addition, social misperceptions surrounding the causes of fistula often lead to stigmatization, ostracism and violence against women. This perpetuates the cycle of marginalization, preventing affected women from seeking help and support.

Situation in Togo

Togo, like other countries in West and Central Africa, has a high rate of obstetric fistulas. The exact prevalence is difficult to determine, with estimated rates ranging from 1,200 to 1,500 cases according to Johns Hopkins University, to a prevalence of 1% among women of childbearing age, or around 18,500 cases according to the 2013 National Demographic and Health Survey. The country is currently implementing its second strategic plan for the elimination of fistula and has a national reproductive health law that provides for free fistula treatment.

Eradication efforts

Efforts to eliminate obstetric fistula require a holistic, multi-sectoral approach involving governments, healthcare providers, international organizations, civil society and affected communities. By addressing the underlying causes and providing appropriate care and support to the women concerned, obstetric fistula can be prevented and treated, enabling women to regain their health, dignity and quality of life.

On December 15, 2022, the United Nations General Assembly adopted a resolution recognizing the urgent need for comprehensive and sustainable development of quality health care treatment and services, including quality emergency obstetric services. The resolution also highlights the links between poverty, lack of education for women and girls, gender inequality, lack of access to health services, early motherhood and early and forced child marriage as root causes of obstetric fistula. It calls on states to take accelerated action, including on sexual and reproductive health, for women and girls.

Regional progress has been observed thanks to initiatives such as the South-South and Triangular Conference for the Elimination of Obstetric Fistula in West and Central Africa held in Abidjan, Côte d'Ivoire, with the adoption of the Abidjan Declaration, which testifies to the commitment of governments to prioritize the elimination of obstetric fistula by 2030.

 

A high-level event on obstetric fistula was organized on the sidelines of the 77th UN General Assembly by UNFPA in partnership with the governments and First Ladies of Togo, Gambia, Burkina Faso and Côte d'Ivoire. The event, entitled "Towards the elimination of obstetric fistula by 2030: A call for transformative action and strategic partnerships to address West and Central Africa's protracted crisis", strengthened partnerships with the First Ladies of West African countries who are already at the forefront of advocacy, engagement and resource mobilization to end obstetric fistula in West Africa. In 2017, the First Ladies of ECOWAS countries signed a Declaration calling for more action. A call followed by a resolution from ECOWAS health ministers in June 2018.

Investing in prevention

It is imperative to invest in the prevention and comprehensive care of obstetric fistula. This includes access to quality sexual and reproductive health services, especially emergency obstetric care. Adequate training and availability of qualified fistula surgeons and midwives are essential elements of sustainable health systems.

To reinforce UNFPA's existing efforts with the Global Campaign to End Fistula, the country offices of Côte d'Ivoire, Burkina Faso, Togo and The Gambia have launched the Global Coalition to End Fistula. Launched in September 2022, this initiative led by the Kingdom of Belgium aims to eliminate obstetric fistula and its root causes by 2030.

A call to action

It's time to form a united front against the silent suffering of women and girls affected by obstetric fistula. We must break the chains of this devastating condition that robs them of their dignity, their health and their future. Unite as advocates, policymakers, healthcare providers and global citizens to eliminate obstetric fistula by 2030. We have the knowledge, the resources and the moral obligation to make this a reality. It's time to act decisively, invest generously and prioritize the needs of people living with obstetric fistula. We can end the scourge of obstetric fistula and forge a future of equality, dignity and reproductive health for all. Together, we can achieve this transformative goal. The time to act is now.

Gamé KOKO