UNFPA Dispatch, November 2011
UNFPA Dispatch, November 2011 edition
November 2011 Global Fistula champions and advocates praised in Maputo page 2 Kenya From fistula survivor to global advocate page 7 Editorial This issue of Dispatch has a special focus on fistula advocates, women who experienced obstructed labor without timely access to the care they needed, and now work as advocates to raise awareness about the problem. Fistula champions and advocates praised for their work Global The annual meeting of the International Obstetric Fistula Working Group, We were delighted to have two fistula survivors with us for the from 10-12 October 2011, offered an opportunity to discuss local annual meeting of the International Obstetric Fistula Working advances in the fight against fistula. According to Ms. Gillian Slinger, Group. They participated actively to help steer activities forward in Coordinator of the global Campaign to End Fistula, “it was a pleasure to the areas of fistula prevention and social reintegration of survivors. meet national authorities and to pay special tribute to some of the heroes Prevention is undoubtedly the most important factor to stem the tide of women living with fistula. However, we still need to address the huge backlog of cases, which demands that we work on solid training and credentialing processes to ensure high-quality treatment. in the fight against fistula.” Dr. Alexandre Manguele, Minister of Health of Mozambique, paid a special tribute to Dr. John Kelly, a British fistula surgeon who has worked for more than 40 years on fistula in different parts of the world. Professor Gordon Williams of the Addis Ababa Fistula Hospital accepted a certificate and gift on behalf of Dr. Kelly, who was unable to Champions in this area were also praised for their commitment attend the meeting. Fistula surgeon Dr. Aldo Marchezine was also praised to train other professionals and keep up with their work. for his outstanding contribution to the fight against fistula in Mozambique. Yet, despite the advances, about five percent of fistula patients will The Minister of Health of Mozambique, Dr. Alexandre Manguele, still be deemed inoperable, while up to 25 per cent will experience met fistula advocates Ms. Sarah Omega and Ms. Norah Amisi Otondo, a degree of incontinence following surgery. Such cases need the praising them for their efforts and achievements as fistula advocates in dedication of specialized professionals and long term follow-up Kenya and congratulating them for their participation in the meeting. and support. The challenges are many, we know. But we must have hope and be inspired by the hard work and courage of our advocates and champions. As beautifully said by Dr. Joseph Ruminjo, of EngenderHealth, “for these most vulnerable of the vulnerable, a culture of possibility and hope is now overdue.” Gillian Slinger During the meeting in Mozambique, there was a high-level dialogue among fistula experts from around the world, partners and national officials to review the situation of more than 2 million women and girls who still live with the condition. “The story unfortunately is the same in so many places. A neglect of the serious needs of these women, who have no option to access needed services that would have avoided the shame and suffering that has come to them as a result,” said Mr. Mark Bennett, CEO Hamlin Fistula Ethiopia. Coordinator, Campaign to End Fistula What is fistula? Obstetric fistula is a childbirth injury caused by prolonged, obstructed labour, without timely medical intervention—typically a Caesarean section. During unassisted prolonged labour, the sustained pressure of the baby’s head on the mother’s pelvic bone damages her soft tissues, creating a hole—or fistula—between the vagina and the bladder and/ or rectum. The pressure prevents blood flow to the tissue, leading to necrosis. Eventually, the dead tissue sloughs off, damaging the original structure of the vagina. The result is a constant leaking of urine and/or feces through the vagina. It’s estimated that over 2 million women live with the condition in the world, with up to 100,000 new cases every year. Fistula is both preventable and, in most cases, treatable. COVER PHOTO: After a successful fistula repair, Adeila Pinto, 33, teaches in the local school on the mountainside of Mossurize. She developed fistula four years ago after prolonged obstructed labor when she was pregnant with her third child. The baby didn’t survive. Adeila is thrilled that she is able to teach again since she believes that education is key to end fistula. “I wish that women would learn to read and write, as education brings women new opportunities and self-worth.” Photo: Gloria Santos, Mozambique, 2011. 2 Dr. Alexandre Manguele praises Sarah Omega and Norah Amisi Otondo for their efforts and achievements as fistula advocates. News Congressional briefing A U.S. congressional briefing organized in Washington D.C. on 24 May by Rep. Carolyn Maloney and Campaign to End Fistula partners — EngenderHealth, USAID, the Fistula Foundation, Human Rights Watch, International Women’s Health Coalition and UNFPA— highlighted strategic approaches to the fight against obstetric fistula. Learn more. Maternal Health Thematic Fund Report UNFPA’s Maternal Health Thematic Fund, a focused initative to accelerate progress towards saving women’s lives and achieving universal access to reproductive health, launched its annual report Kate Grant, Executive Director, the Fistula Foundation, registers to attend the International Obstetric Fistula Working Group meeting in Mozambique. Photo: Benedicte Desrus, Sipa Press/Campaign to End Fistula. in May. The publication presents the results achieved in countries supported by the fund—including the ones covered by the Campaign to End Fistula— outlining activities and looking ahead at future challenges. Read the full report. Read the fistula chapter. According to Mr. Bennett, the solution in one way is simple and it is Training manual strongly connected with timely access to skilled birth attendants and The International Federation of Gynecology and Obstetrics (FIGO) quality health services, including emergency obstetric care. Yet its achieve- co-ordinated the production of a training manual, the Global ment is enormously challenging in many countries. Competency-Based Fistula Surgery Training Manual, aimed at “Infrastructure, communication and transportation conditions directly healthcare providers from low- and middle-income countries involved affect access to services,” said Mr. Bennet, highlighting that health profes- in the prevention and management of fistula. Access the FIGO sionals are usually also in short supply. Training Manual on line. According to him, in Ethiopia, one of the largest countries in SubSaharan Africa, there are less than 1,500 active midwives and around How to portray fistula survivors 150 doctors who can offer comprehensive care to women who need help Fistula survivors are women who experienced prolonged, obstructed during childbirth. labour and developed obstetric fistula. The Campaign has developed “It’s simple math. Very few women in rural areas have access to the guidelines on how to portray women who live with the condition, care they need,” Mr. Bennet added, saying that quality training, infrastruc- highlighting the links between obstetric fistula and maternal health in ture and innovations are critically needed to really make a difference. general to help empower, not victimize them. Learn more. New web site launch The new Campaign to End Fistula web site, launched in June, is the result of a collaborative effort by several partners at global level and in the countries covered by the Campaign to End Fistula. Powered by UNFPA, the site provides a dynamic and interactive platform, so that all Campaign partners can share news, data and stories: www.endfistula.org. In the media This year’s meeting of the International Obstetric Fistula Working Group in Maputo, Mozambique, was covered by several national and international journalists resulting in substantial media coverage. Also, in June, Yo Dona, a prestigious weekly magazine distributed as part of El Mundo newspaper, published an article about the efforts to fight fistula in Senegal. Read the full coverage. Professor Gordon Williams of the Addis Ababa Fistula Hospital accepted a certificate from Gillian Slinger, on behalf of Dr. John Kelly. Read more: www.endfistula.org 3 dispatch Maternal health advocate visits fistula center Zonta president-elect reaffirms support to end fistula Dhaka, Bangladesh Phebe, Liberia Maternal health advocate and founder of the Every Mother Counts Ms. Lynn McKenzie, the president-elect of Zonta International—a global campaign, Christy Turlington Burns recently visited the National Fistula service organization of executives and professionals working together Center at the Dhaka Medical College in Bangladesh. to advance the status of women—visited Liberia to learn more about There, she met patients waiting for a fistula surgery that can poten- the efforts to end obstetric fistula and reduce maternal mortality in the tially transform their lives. She also learned more about obstetric fistula, country. Zonta has funded and supported the fight against fistula in a childbirth disability that affects up to 2 million women in the world, Liberia for three years. leaving them chronically incontinent, ashamed and isolated. “One of the patients we met in the pre-operative room was “Fistula is an isolating, depressing condition, which is both preventable and can be treated with significant success,” said Ms. McKenzie, 45-years-old and had been suffering from fistula for 12 years. In the adding that the Liberian fistula programme will succeed as it draws next bed was a girl who looked to be no older than 15 or 16-years-old. together four critical components—awareness to prevent fistula, Both women had lost their babies during their deliveries. These girls treatment for those with fistula, rehabilitation including the opportunity are the key and we were reminded that future mothers count too,” to learn new economic skills, and finally the support of the people and Ms. Burns said. Government of Liberia. In Bangladesh, an estimated 71,000 women live with the condition “Through this programme, women are given a ‘help up’ and not a ‘hand and every year there are another 3,000 to 4,000 new cases according out.’ I left Liberia, knowing Zonta’s investment is being used to transform to a needs assessment study carried out in the country in 2003. women’s lives and giving them back their lives and smiles,” she affirmed. The center at the Dhaka Medical College provides repair surgeries As part of her visit, Ms. McKenzie met Health and Social Welfare free of charge and refers fistula survivors to a rehabilitation center, authorities to discuss efforts to improve maternal health, and held where they can learn how to adjust as they go back to discussions with partners involved in the provision of fistula services in their communities. the country. According to Ms. Burns, like so many development issues, this is one While in Liberia, she participated in the launch of the 2011 nationwide that requires a holistic approach. “Prevention is as important as treat- fistula repair campaign in Kakata, Margibi County, where she had the ment to prevent fistulas and maternal mortality, but rehabilitation is also opportunity to hear the stories of women awaiting fistula surgery at the C. paramount for the full recovery of those who have received treatment H. Rennie Hospital. so that they can reenter society,” she explained. Read the blog post. During her visit, Ms. McKenzie also travelled to Bomi and Bong counties. Accompanied by health officials, she toured major health facilities providing reproductive health services for women and girls and spoke with patients as well as health workers. In Phebe, Bong County, the president-elect visited the Fistula Rehabilitation and Reintegration Center. “Fistula is a condition no woman should have to endure,” she said to the almost 30 fistula survivors who, after receiving treatment, are now being trained in the skills they need to successfully reintegrate into their communities. She urged them to become ambassadors and role models for those who did not have the same opportunity. “You have to encourage other women living with fistula to come out and seek help, so that they can also enjoy the independence and freedom you now have,” Ms. McKenzie said. Sando Moore, one of the fistula survivors benefiting from the rehabilitation programme at the center, told Ms. McKenzie how she had been discriminated against by her family and community. “I am feeling great after the successful operation. I can now sit down for more than one hour without running to the toilet or wetting myself. Before, no one would say hello to me, including even most of my family members. They believed it was a curse that befell me,” said Ms. Moore, thanking Zonta International and UNFPA for helping her regain dignity Maternal health advocate and founder of the Every Mother Counts campaign, Christy Turlington Burns visits the National Fistula Center at the Dhaka Medical College in Bangladesh. Photo: Josh Estey, Bangladesh, 2011. 4 and respect. Calixte Hessou reported from Liberia. Delivering hope to women with fistula in West Africa Bo, Sierra Leone Aminata says she is 19 but the nurses explain that she is actually younger. The task force has been advanced by the First Lady, Mrs. Sia Nyama According to them, she worries about being judged for becoming pregnant Koroma, with support from UNFPA. As a champion of maternal health at such a young age. She has already undergone one fistula repair but will issues in Sierra Leone, Mrs. Koroma has been vocal about the importance still need a second surgery to repair an obstetric fistula developed when of reducing the number of teenage pregnancies and addressing obstetric she tried to deliver her baby at home with a traditional birth attendant. fistula. In Sierra Leone, a coastal country in West Africa bordered by Guinea and Liberia, as many as 970 out of every 100,000 live births result in maternal deaths. Many more women suffer birth-related injuries, including obstetric fistula. While these efforts have the potential to help eliminate fistula, the resources available are extremely limited. “Presently, there are only two fistula centers providing fistula repairs in the country,” says the coordinator of the Campaign to End Fistula, Ms. Still recovering from an 11-year civil war, the country faces challenges in many areas, women’s health probably being one of the most difficult to Gillian Slinger, who visited Sierra Leone in July. One of them is the Aberdeen Women’s Centre, in Freetown, which address. Poverty, cultural issues, lack of infrastructure and information, receives support from the Freedom From Fistula Foundation and UNFPA, combined with high teenage pregnancy and home delivery rates add to a and hosts the only Sierra Leonean fistula surgeon, Dr. Alyona Lewis, as dire scenario and sobering statistics. well as international fistula experts when they come to the country to Moreover, women are also vulnerable to disabilities like obstetric fistula, perform surgeries. resulting from barriers to accessing emergency obstetric “The situation is very difficult. An care, which stem from infrastructure problems and estimated 40 per cent of fistula cases in issues relating to culture and information. the Aberdeen Women’s Centre also present In an effort to change the situation, the country is footdrop, a consequence of nerve damage developing special policies to improve maternal health. sustained during obstructed labor, leading to Since 2010, all pregnant and lactating women became an inability to use the lower limbs and hence entitled to free health care. making it very difficult for the patient to walk,” According to local authorities, in less than two Ms. Slinger explains. years after the policy was put in place, maternal deaths The other fistula repair center in Sierra dropped throughout the country as more women and Leone is the West Africa Fistula Centre, at girls are reportedly seeking health facilities for antenatal the Government Hospital in Bo. Dr. A. Philip care and emergency services in case of complications. Koroma, the center’s medical superviser, Despite difficulties to collect data, it is almost hopes to expand the programme. certain that there has been a reduction in the number of “We realized that the bulk of fistula fistula cases as well. New cases seem to mostly occur amongst young women like Aminata, emphasizing early pregnancies as one of the major risk factors leading to fistula in Sierra Leone. patients are from other provinces,” explains Aminata, approximately 19. At the time of the photo, she had already undergone one fistula repair but would still need a second surgery to repair the fistula in her birth canal. Poor access to emergency obstetric care is another Dr. Koroma, adding that some of them come from places as far as Kabala, a 250 km drive from Bo. He assists Dr. Darius Maggi, a Texan major risk factor. While the elimination of antenatal care fees has likely con- surgeon who travels to Sierra Leone two or three times a year to tributed to the reduction of maternal deaths in the country, many pregnant perform fistula surgeries at the center and in other parts of the country. women still have to face severe transportation barriers. “Every time Dr. Maggi comes, he does up to 20 fistula repairs,” says Dr. Women living in rural areas often cannot reach health care facilities in Koroma, explaining that more than 60 per cent of the funding for these time, especially during the rainy season when flooded roads tend to isolate surgeries comes from Texans who generously support the charity work entire communities for days. in Sierra Leone. When a woman is experiencing obstructed labor, proper transportation and “At the center, patients receive skills training as part of the social access to emergency obstetric care can make the difference between life and reintegration process,” says Ms. Slinger, mentioning that family and death for both the mother and the baby. It can also help prevent disabilities. friends of the recovered patients are invited to a post-operation To deal with these problems, a National Task Force for Fistula was es- ceremony, which also helps with the reintegration when the fistula tablished in early 2011, including representatives from the Ministry of Health, survivors are back to their communities. At the time of her mission to the Aberdeen Women’s Centre, the West African Fistula Centre, the Haikal the country, there were 50 women awaiting treatment in Bo. Foundation, Health Poverty Action, Health for All Coalition and UNFPA, the United Nations Population Fund. Angeline Martyn, Americans for UNFPA, reported from Sierra Leone. 5 dispatch Planning a future No more suffering in silence by Agnes Odhiambo, Human Rights Watch Mossurize, Mozambique Lusia Muiambo got pregnant at the Mwendwa P. was 16 when she became pregnant for the first time. age of 15. When it was time to give When she went into labor, she did not want to go to the hospital near birth, she went into labour at home her town because, as she told me, “I had heard that nurses abuse girls in Mossurize, a 15-hour drive from who get pregnant when they go to deliver.” Maputo, the capital of Mozambique. After four days, she was finally taken to a hospital, but it was too late. Her Lusia, 19, is determined to wait to become pregnant again until she is physically and emotionally prepared to have a child. She is careful to always use contraceptives. Photo: Gloria Santos, Mozambique, 2011. Mwendwa went through painful labor at home for close to 24 hours before going to the hospital. There, her fears were confirmed. A few years later, when Mwendwa was in labor with her fourth child, baby was already dead and she had she could not face the mistreatment again and decided to deliver at developed a fistula. home with a traditional birth attendant. In Mozambique, as many as Unfortunately, she had complications. She developed obstetric 500 out of every 100,000 live births fistula, which caused her to leak urine and feces constantly for years. result in maternal deaths. For Finally she got treatment through a fistula surgery “camp” far from every woman who dies of maternal her home. related causes, at least 20 women When I asked Mwendwa why she had not sought treatment for experience a childbirth disability, of fistula at the provincial hospital close to her home, I learned that which obstetric fistula is one of the Mwendwa had faced poor treatment in health facilities many other most severe. times, including once when her child was severely ill. “Maternal deaths and disabilities could be substantially reduced She told me, “I was referred there [to the hospital] to take the baby if every woman had access to key sexual and reproductive health because she had diarrhea and a cough. The child was very ill. Instead interventions,” says Dr. Yves Bergevin, Senior Maternal Health Advisor they kept me waiting. I had to go back home. They talk very badly. and Coordinator of the UNFPA Maternal Health Thematic Fund. They just toss you from one person to another. They don’t even care. I For him, voluntary family planning, antenatal care, skilled attendance at birth and emergency obstetric care should be universally available, could not go back there.” The poverty of the health care system itself results in a climate in especially for young women and women in rural areas. “This would which patient abuse and mistreatment is widespread, but often goes help address vulnerabilities and complications associated with early unreported and carries no consequences. pregnancy and obstructed labour,” Dr. Bergevin says. Lusia, 19, underwent three fistula surgeries before being healed. Fistula would rarely occur in countries where women had access to family planning information and services to make informed choices Now recovered, she has renewed hopes for the future, which doesn’t about their sexual and reproductive lives and to skilled birth attandants necessarily include children right away. and emergency obstetric care when they needed it. “I want to postpone having children until later in life,” says Lusia Distance, cost, lack of autonomy, lack of transport, lack of informa- Muiambo. Now that her fistula is repaired, Lusia hopes to return to school tion about potential complications during pregnancy and childbirth, the and build a better future for herself. advantages of facility deliveries, and other barriers stand in the way of “When I still had a fistula, I didn’t like to go to school because of my bad smell, but now I am eager to learn how to read and write. many women who need such care. But for others, experience with abusive and poor-quality care, and And, hopefully, one day, I will start my own business at the local the lack of means to seek redress for poor treatment in health facilities market,” she says. without facing retaliation keeps them from seeking to deliver their The government of Mozambique has placed significant emphasis on accelerating efforts to promote family planning in the country, ensuring that appropriate information and services are available. With UNFPA support, the goal is to reach a 25 per cent contraceptive prevalence rate by 2014, a considerable increase compared with the current rate of 12 per cent. This will also help reduce maternal health-related problems, since the reduction of unplanned pregnancies could help prevent maternal babies in health facilities that offer skilled care. Fistula survivors would have a lot to tell about what stopped them from seeking skilled health care during labor, what problems they encountered in health facilities, or what deterred them from seeking surgical repair. Their insights could make a real difference in improving the health system and helping other women have healthy, safe deliveries and avoid fistulas. deaths and disabilities. Proper follow-up and family planning after recovery also helps prevent fistula recurrence in patients who underwent successful treatment. Helene Christensen reported from Mozambique. 6 This article is part of a series originally published by RH Reality Check. All articles in this series represent the views of individual authors and their organizations and do not necessarily reflect the newsletter editorial position, the official position of UNFPA or the Campaign to End Fistula. National surveillance system Asia and Pacific From fistula survivor to global advocate Bangladesh and Nepal are revolutionizing the response to obstetric fistula Kenya, One By One as they prepare to address a vital but often overlooked component of fistula programmes—the early identification of women living with fistula With a maternal death ratio of 530 deaths per 100,000 live births, Kenya so that treatment can be provided as soon as possible. struggles with disabilities associated with childbirth, like fistula. Of the 3,000 An innovative national surveillance system is being planned to facilitate fistula management, as well as develop and strengthen the capacity of obstetricians and other health professionals on issues related to fistula prevention and treatment in both countries. The system is expected to be put in place in 2012 as a pilot project in selected districts of Nepal and also in Bangladesh, where the minister of new cases that occur each year, only approximately 7 per cent are able to access treatment. Sarah Omega is one of the fortunate ones. “I lived with fistula for twelve years and the reason that I lived with it for that long was because I didn’t have information about treatment in Kenya,” said the fistula survivor and advocate. Ms. Omega is an example of courage and resilience. After surviving the Health and Family Welfare, Dr. Mujibor Rahman Fakir, is a strong supporter ordeal of fistula and regaining her place in society, she became an advocate of the initiative: “If we can ensure safe delivery and safe motherhood, one for the Campaign to End Fistula and is now Outreach Manager in Western day obstetric fistula will be history.” Kenya for One By One’s Let’s End Fistula initiative. The system will use community midwives and primary health care “Because I know what it feels like, a woman leaking urine, the trauma workers to establish a vital link between the public health sector and that is attached to the condition... I decided I’ll not just sit back and let private practitioners, including obstetricians, gynecologists and urologists. other women suffer in silence, just the way I suffered in silence,” she added. “The practitioners are key elements of the system,” explains Dr. Vinit Sharma, UNFPA regional advisor for reproductive health. The backbone of the system is composed of reporting units— Through One By One, a U.S.-based non-profit dedicated to the eradication of obstetric fistula, Sarah Omega is working very closely with communities and local leaders to raise awareness about the importance of community midwives, practitioners, hospitals and other health facilities preventing fistula, ensuring access to free treatment, and ending the stigma in the government and the private sector— that are likely to see cases associated with the condition. of obstetric fistula. They will be required to submit monthly reports, even if no cases are Sarah is training and supervising a network of fellow fistula survivors and community volunteers, men and women, to educate their own communities identified in the period. “This serves as a cross-check to ensure that all about fistula, find and bring fistula patients in for care, and provide reintegra- identified fistula cases are being reported,” explains Dr. Sharma. tion support for women when they return home following treatment. Notifications work as an alarm: When a new fistula case is detected, To tell fistula experts from around the world about their experience it has to be immediately communicated to the district health officer. with Let’s End Fistula in Kenya and to help steer the fistula agenda All cases must be immediately investigated, usually within 72 hours of forward, Sarah Omega and one of her first trainees, Norah Otondo, were notification. invited to participate in the annual meeting of the International Obstetric A trained medical officer is then sent to examine the fistula survivor at her place of residence and collect her medical history. If the diagnosis is confirmed, the patient is referred to a fistula centre for treatment. The district health officer is responsible for making arrangements Fistula Working Group, in Mozambique. “It was the first time that fistula survivors actively participated in this forum, attesting not only to their own capacity and total reintegration into society, but, more impor- regarding surgery, post operative care, rehabilitation and social re-integra- tantly, showing the international tion. The area must also be searched for other unreported cases, but each recognition of the role of fistula case identified and referred for treatment is in itself a victory. survivors as advocates,” said Ms. “If you cure one obstetric fistula case, you have given meaning of life to someone who unfortunately has lost it due to social injustice and health system failure,” explains Dr. Pushpa Chaudhary, president-elect of the Nepal Society of Obstetricians and Gynaecologists. Using geographic information, the national data management team Gillian Slinger, coordinator of the Campaign to End Fistula. “Former fistula patients have a deep understanding of how to work effectively with other fistula will map the location of the cases in the actual district where the case patients and their families. They occurred, so that appropriate action can be planned and other unidentified are in a unique position to have a cases may also be discovered and referred for appropriate treatment. very powerful impact, and we are International experts agree about the importance of putting such already seeing incredible progress systems in place. According to Dr. Tom Raassen, of the International in Western Kenya,” complemented Society of Obstetric Fistula Surgeons, “to plan surveillance of women with Heidi Breeze-Harris, co-founder obstetric fistulas is a great opportunity to find those women at the earliest and executive director of One possible moment, before they have become social outcasts.” By One. Sarah Omega, fistula survivor and advocate. Photo: Benedicte Desrus, Sipa Press, 2011. 7 dispatch Unleashing the power of women and girls Washington, D.C. The world’s population just topped 7 billion. This unique moment in human history represents both an opportunity and a challenge, and will have an impact on every single person on the planet, but especially on women and girls. “Advancing the needs and rights of women and girls not only enhances their well-being and productivity, but it also improves prospects for generations to come,” said the U.S. Department of State Global Health Initiative executive director, Ms. Lois Quam, at a panel discussion at National Geographic headquarters on 13 September. The event, Unleashing the Power of Women and Girls, which was part of the 7 Billion Actions campaign led by UNFPA, brought together some 500 people to discuss the many challenges facing young women in a world of seven billion. Invited panelists addressed a wide range of issues, from access to reproductive health care to education and the empowerment of women. Singer and actress Natalie Imbruglia talked about her travels as Virgin Unite ambassador and spokesperson for the Campaign to End Fistula, recalling the women she met who did not have a choice as to when to have children. Many of them, mired in extreme poverty, social inequality and unbalanced power relations, barely survived pregnancy and labour to live in pain, shame and isolation. Singer and actress Natalie Imbruglia, spokesperson for the Campaign to End “Every woman in the world should Fistula. Photo: Skip Brown, 2011. be able to deliver safely. In whatever way that we can, we have to raise awareness about this,” she said. The UNFPA Executive Director, Dr. Babatunde Osotimehin, highlighted that 900 million young women in the world today do not have access to the information, opportunities or services they need. “They don’t have access to reproductive health and they cannot accede to high positions. We have to make sure that they know their rights so that they can reach their potential.” This article was originally published on the UNFPA global web site. Why the Campaign? Every year, 7-10 million women suffer severe or long-lasting illnesses or disabilities caused by complications during pregnancy or childbirth, including obstetric fistula. Obstetric fistula is a preventable and, in most cases, treatable childbirth injury that leaves women incontinent, ashamed and often isolated from their communities. There are at least 2 million women living with obstetric fistula in the developing world, and up to 100,000 new cases occur each year. In 2003, UNFPA and its global partners united to launch the Campaign to End Fistula, now present in 50 countries. Since 2009, the UNFPA contribution to the Campaign has been programmatically integrated into the Maternal Health Thematic Fund, launched in early 2008 by UNFPA to support priority countries in their efforts to improve maternal and newborn health. This integrated approach is contributing to further strengthen efforts to prevent obstetric fistula through improved access to quality maternal health services. The Campaign, with its many partners around the world, focuses on three key areas: preventing fistula, treating affected women, and supporting women as they recover from surgery and rebuild their lives. For more information, please visit: endfistula.org. Afghanistan Pakistan Nepal Bangladesh India Mauritania Mali Niger Chad Eritrea Senegal Yemen Sudan Burkina Gambia Faso Djibouti Guinea Bissau Guinea Nigeria Côte Sierra Ethiopia Central African d’Ivoire Leone Liberia Cameroon Republic Ghana Benin Somalia Uganda Togo Congo Kenya Equatorial Gabon Democratic Guinea Rwanda Republic Burundi of Congo United Republic of Tanzania Angola Zambia Malawi Zimbabwe Mozambique Madagascar Swaziland CARIBBEAN Haiti South Africa Lesotho Campaign to End Fistula countries The designations employed and the presentation of material on the map do not imply the expression of any opinion whatsoever on the part of UNFPA concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. UNFPA Campaign to End Fistula 605 Third Avenue, New York, NY 10158 email: firstname.lastname@example.org dispatch is a biannual newsletter highlighing developments in the Campaign to End Fistula Editorial Process: Etienne Franca Design and Printing: Prographics, Inc. The opinions expressed by the persons interviewed and original authors do not necessarily reflect the newsletter editorial position, the official position of UNFPA, or recognition of geographic boundaries or countries. Contributors: Erin Anastasi, Carolyn Anderman, Astrid Bant, Mark Bennet, Yves Bergevin, Luc de Bernis, Heidi Breeze-Harris, Helene Christensen, Sarah Craven, Abubakar Dungus, Patricia Guzman, Calixte Hessou, Katja Iversen, Jarrie Kabba-kebbay, Richard Kollodge, Laura Laski, Rachel Machefsky, Angeline Martyn, Amir Modan, Debora Nandja, Ratidzai Ndlovu, Agnes Odhiambo, Geoffrey Okumu, Mizanur Rahman, Joseph Ruminjo, William Ryan, Jennica Sehorn, Vinit Sharma, Gillian Slinger, Erin Thornton, Antonio Tivane, Amancio Vilanculos. Campaign Donors (since 2003) Americans for UNFPA Arab Gulf Programme for UN Development Organizations Bill & Melinda Gates Foundation through EngenderHealth European Voice Government of Australia Government of Austria Government of Canada Government of Finland Government of Iceland Government of Ireland Government of Japan (through the UN Trust Fund for Human Security) Government of Luxembourg Government of New Zealand Government of Norway Government of Poland Government of the Republic of Korea Government of Spain Government of Sweden Government of Switzerland Johnson & Johnson Kingdom of Spain, Autonomous Community of Catalunya One by One United Nations Foundation Virgin Unite Women's Missionary Society of the African Methodist Episcopal Church Zonta International UNFPA wishes to acknowledge with gratitude the multi-donor support generated towards strengthening and improving maternal health in the world, through its core resources, through the Maternal Health Thematic Fund and through specific funding for fistula. Our appreciation is also extended to the numerous partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.