Obstetric fistula 

Obstetric fistula remains one of the most severe and tragic childbirth injuries. It manifests as a hole between the birth canal and bladder and/or rectum, typically resulting from prolonged, obstructed labour without access to timely, high-quality medical care. This condition causes women to leak urine, faeces, or both, leading to chronic health problems, depression, social isolation, and exacerbating poverty.

Despite significant progress in many areas, hundreds of thousands of women and girls across sub-Saharan Africa, Asia, the Arab States, and Latin America and the Caribbean continue to suffer from fistula, with new cases emerging each year. Obstetric fistula is largely preventable, and its persistence underscores global inequalities and the shortcomings of health and social systems in safeguarding the health and human rights of the most vulnerable women and girls.

Sierra Leone is one of 50 countries participating in the global campaign to end obstetric fistula which was launched in 2003.

UNFPA's Efforts in Sierra Leone and Comprehensive management of obstetric fistula in Sierra Leone

The UNFPA country office is leading efforts to address obstetric fistula in Sierra Leone by supporting key government ministries and collaborating with local NGOs. 

Central to these efforts is the Iceland-funded project, which aims to institutionalize fistula care based on the National Strategy to End Fistula in Sierra Leone. This project ensures a structured approach to managing fistula, from patient identification through surgical repair, rehabilitation, and reintegration.

A major focus of the project is training and capacity building, which equips community-based organizations and male clubs, schools, teachers and health care providers with skills to identify and refer fistula patients effectively. This training is crucial for improving detection and management across the country.

The project also integrates fistula prevention into antenatal care (ANC) by embedding preventive measures and implementing post-labor screening to reduce fistula incidence and ensure early intervention and detection of cases.

Additionally, a significant milestone has been the establishment of Sierra Leone's first government-run fistula surgery theatre in Bo, which enhances access to specialized surgical care and improves treatment outcomes.

In 2023, and with support from the Government of Iceland, UNFPA intensified efforts in community outreach and disseminating information on obstetric fistula prevention, identification and referral of patients with the aim to reduce the occurrence and reduce a possible backlog of patients.  

• Efforts included distributing leaflets, posters, and radio jingles, and holding community dialogue meetings to raise awareness about fistula prevention. Radio discussions with fistula survivors as advocates for prevention and treatment were held and the social media presence increased.
• UNFPA supports secure environments for survivors of violence, providing counseling, education, and skills training for reintegration and empowerment, including information on early marriage and fistula prevention.
• A total of 35 community action group members in the target districts of the project were trained in mobilization for fistula prevention, an increase from previous years. This expanded capacity is crucial for sustaining local efforts to combat obstetric fistula.
• UNFPA supports Male Clubs, schools, and teacher training, providing education on fistula prevention and safe childbirth practices to enhance community awareness and maternal health.
• 270 girls and women from all districts, presenting with symptoms of obstetric fistula, were screened. Of these, 124 were found to have fistula and received restoration surgery. 
• In addition to essential medical treatment, all patients receive a range of comprehensive support services, including mental health care, basic skills training, and reintegration assistance. UNFPA, in collaboration with an implementing partner, provided extended livelihood skills training to 60 fistula survivors. This training includes soap making, catering, tailoring, and adult literacy. Survivors also receive starter kits for their chosen skills, seed money to help launch their businesses, and wellness kits with essential hygiene products.
• To ensure continued support, all patients are followed up at three and six months post-treatment. This follow-up helps address any further needs and provides additional support as required. Additionally, patients are assisted in accessing care for cesarean deliveries for any future pregnancies.

UNFPA remains committed to ending obstetric fistula in Sierra Leone through continued support for prevention, treatment, and rehabilitation initiatives. Through these comprehensive efforts, UNFPA and its partners are working to transform fistula care in Sierra Leone, aiming for a future where no woman or girl suffers from this preventable condition.