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Obstetric fistula

Obstetric fistula

Obstetric fistula is one of the most serious and tragic childbirth injuries. A hole between the birth canal and bladder and/or rectum, it is caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It leaves women leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty.

Hundreds of thousands of women and girls in sub-Saharan Africa, Asia, the Arab States region, and Latin America and the Caribbean are estimated to be living with fistula, with new cases developing every year. Yet fistula is almost entirely preventable. Its persistence is a sign of global inequality and an indication that health and social systems are failing to protect the health and human rights of the poorest and most vulnerable women and girls.

Comprehensive management of obstetric fistula in Sierra Leone

While accurate data on the prevalence of obstetric fistula in Sierra Leone has been challenging, anecdotal evidences and initial modelling projections, estimate that about 2,496 women are living with obstetric fistula in the country. Over the last few years, the UNFPA country office has worked in partnership with two non-governmental organizations (NGOs), Aberdeen Women’s Centre and Haikal, to seek out, treat, train, reintegrate and advocate for young girls and women suffering from obstetric fistula.

UNFPA is the main agency funding fistula interventions in the country. In partnership with Aberdeen Women’s Centre, Haikal and the MoHS, UNFPA restores dignity and hope through a multi-faceted set of services for fistula clients and survivors to ensure holistic restoration.

In 2019, through UNFPA support to Aberdeen Women’s Centre, 104 vesico-vaginal/recto-vaginal fistula surgical repairs undertaken. Radio talk shows were aired in nine local languages through 10 community radio stations providing information on the availability of services. Public notices were screened in 14 districts and reached 8,630 people with vital education needed for prevention, referral and treatment of women with the condition. Through Haikal, 50 obstetric fistula survivors received skills training in income generating activities such as soap-making, tailoring, tie-dyeing, weaving, needlework, agriculture and adult literacy and numeracy lessons. Upon graduation, they received seed money for livelihood activities for their reintegration into their communities.

Training of surgical assistants

The provision of comprehensive emergency obstetrics care services - especially C- sections which is key to fistula prevention - by relieving obstructed labour, is not available to many women with complications due to the lack of adequately skilled medical doctors. To address this situation, UNFPA has been supporting task-shifting and the training of Surgical Assistants.         UNFPA is working with CapaCare to conduct a three-year intensive training programme of community health officers and medical officers in emergency surgical and obstetric care. The graduates from CapaCare are deployed to hospitals across the country, which expands access to surgical care and increases the availability of trained providers to perform C-sections among many other life-saving interventions.

Training of nurse anesthetists

While anaesthetic services are critically required during obstetric emergencies, such specialization is severely lacking in the country. In an effort to improve the quality and availability of emergency surgical and obstetric care in Sierra Leone’s district hospitals, UNFPA has been supporting students on an annual basis in the 18-month long National Nurse Anaesthetist Training Programme. UNFPA provided support for expert lecturers as well as subsistence allowances for the students.