Reproductive Health

Campaign to End Fistula

Overview

Obstetric fistula (OF), a devastating maternal morbidity, is one of the most neglected issues in international reproductive health.7   A fistula is a hole that forms between a woman’s bladder or rectum, leaving her constantly leaking urine or feces.  Obstetric fistula is usually the result of obstructed labour coupled with a lack of appropriate medical intervention - typically a Caesarean section - to relieve it.8   It is a preventable condition which disproportionately affects very young and very poor women, usually living in remote areas, due to early childbearing, pre-existing malnutrition and limited access to emergency obstetric care.  It is treatable through surgical repair, allowing these often-ostracized women a happy and productive return to their families and communities. In 2003, UNFPA launched a global Campaign to End Fistula.  The campaign raises awareness of the issue, conducts needs assessments, and expands services for prevention and treatment.9 

Campaign In Kenya

In Kenya, the campaign got underway in January 2004 when the Ministry of Health with financial support from UNFPA commissioned a rapid needs assessment on the obstetric fistula situation in selected districts in the country where the condition was suspected to be most prevalent namely: Mwingi, Eastern Province; Kwale, Coast Province; Homa Bay, Nyanza Province; and West Pokot, Rift Valley Province.  It is estimated that 3000 new cases of fistulae occur each year with only 7.5% of cases treated annually. The report revealed that harmful cultural practices and poverty in the four districts interact synergistically to precipitate obstetric fistula: early marriage, early sexual debut, the preference to deliver with Traditional Birth Attendants (TBAs), and (long) distances to the facilities are a recipe for prolonged labour, a major precursor of obstetric fistula.10 

UNFPA Kenya is in the process of finalizing and printing the report from the needs assessment for dissemination.  UNFPA helped DRH develop a project proposal to improve obstetric fistula management in Kenya, which was recently submitted to UNFPA HQ in New York for approval.  The project will be implemented by DRH for two years until 2006 with an estimated contribution of $400,000 from UNFPA.  Proposed interventions include: Review of the standard training curriculum for OF management; Purchase of equipment; Training of OF repair experts in the four regions, namely: Machakos General Hospital; Coast Province Hospital; Provincial General Hospital, Nyanza; and Moi Referral Teaching Hospital, Eldoret; Community mobilization for Behaviour Change Communication (BCC) & Prevention approaches/interventions; and Integration of Obstetric Fistula into the on-going Safe Motherhood Initiative.

Further Resources

>> Visit the Campaign website

>> Fact sheet about Obstetric fistula for Kenya