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November 2010

Women Deliver Fistula survivors meet Danish Crown Princess page 6

Africa Fistula is key component of maternal health campaign page 2

Good news for women in Africa

Filling the information gap

Brazzaville, Republic of Congo

Libreville, Gabon On 20 October

A recent survey carried out in 55 health facilities in Gabon is helping

2010 high-ranking

to fill the information gap about obstetric fistula in the country. It also

national officials,

highlights that fistula is a public health problem and should be viewed as

including ministers,

a priority by Gabonese authorities. Although previous studies had already

parliamentarians and

highlighted the lack of emergency care for women with complications

development partners,

during delivery, as well as early pregnancy and lack of skilled profession-

brought good news

als as leading factors of disabilities, some experts denied the existence of

to women in the

obstetric fistula in Gabon.

Republic of Congo. Senate’s First Secretary Ms. Philomène Fouty Soungou, designated by the Health Ministry and UNFPA as the Goodwill Ambassador for CARMMA in Congo. She will work with the First Lady to promote maternal health in the country. Photo: UNFPA, Congo-Brazzaville, 2010.

“There are many factors leading to the occurrence of obstetric fistula

This happened when

in this country. Since the survey, we can name a few, from adolescent

they participated in

pregnancy to the lack of access to health services. But we can’t ignore

the national launch

structural issues like poverty and socio-cultural factors, including the

of the Campaign on

notion that real women should be brave and endure the pain when giving

Accelerated Reduction

birth,” explains UNFPA Country Director for Gabon, Mr. David Lawson.

of Maternal Mortality in Africa (CARMMA), attesting to the commitment to improve maternal health in that country. In the Republic of Congo, maternal death is above the regional average

During the survey, which identified 90 fistula cases in the country, 15 women living with the condition were interviewed. In 50 per cent of the interviews, the women were aged 15-24, the majority of whom had little

at a dire rate of 580 deaths per 100,000 live births. This prompted the cam-

education. More than half of them live in remote rural areas difficult to

paign launch, which was presided over by Congo First Lady Ms. Antoinette

access by the most common means of transportation. Their main source of

Sassou Nguesso, a champion for maternal health and CARMMA in the

income is agriculture.

country. Speaking on behalf of the United Nations, UNFPA Regional Director Mr.

“In these remote areas, it is only to produce the basics, just for subsistence. That’s why these women are so vulnerable – most of them live under

Bunmi Makinwa assured the Government of the UN’s support to acceler-

the poverty line,” explains demographer Mr. Mbadu Muanda, the survey’s

ate the improvement of maternal health in Africa. The Minister of Health,

lead consultant.

Prof. Georges Moyen, reaffirmed the Government’s commitment to tackle

All the fistula survivors interviewed had their first pregnancy before

maternal death as a top priority in the country, and he is following up his

they had turned 19 and almost half of them even before they had turned

words with action.

16. One out of every three fistula cases occurred after the first childbirth.

“The Government has initiated a series of measures to reverse the

For most of the interviewed women it took more than 12 hours before

trend,” said Minister Moyen at the launch. “We have established a mater-

they arrived at a hospital after labour began and a complication was identi-

nal health observatory and we are promoting public awareness about the

fied. Three of them spent almost 24 hours getting to a health facility. The

importance of women and children’s health. Caesarean sections will be

majority of them delivered a still-born baby.

carried out for free in the public health system and we are also committed

“The fact that more than 50 per cent of the fistula cases occurred

to the Campaign to End Fistula and the extension of the UNFPA programme

after childbirth and the rest after a surgical intervention may reflect poor

on this issue.”

emergency obstetric care. And since the majority of the women delivered in

With as many as 140 cases already identified in the country and poten-

a health facility, it leads us to think that more training is needed, as well as

tially many more likely to be found, obstetric fistula is considered a serious

more adequate equipment and supplies in case of complications,” says Mr.

public health issue in the Republic of Congo, a country in sub-Saharan

Mbadu Muanda.

Africa with an estimated population of more than 4 million. Since 2007, UNFPA has invested over $400,000 in the prevention and

To help eradicate fistula in Gabon, the Campaign and its partners advocate for the establishment of free delivery services and more skilled

treatment of this problem in the country, where precarious conditions and

care in the country, says Mr. David Lawson. “We are working to enhance the

poor access to maternal health services contribute to high rates of maternal

capacity of health personnel and to improve the maternal health services

death and disability.

available to the population. This goes together with efforts to sensitize the

The extension of the fistula programme to two additional treatment centers, one in Pointe Noire and the other in Owando, is a key part of

population about obstetric fistula and early pregnancy, as well as provide better access to family planning and help empower women.”

UNFPA’s contribution to CARMMA in Congo. Fistula treatment is currently provided free of charge at two major health centres in Brazzaville. With additional resources, the hope is that more fistula centres will open in the coming months. The addition of these new centres will significantly reduce the distance that women with fistula need to travel for treatment.


COVER PHOTO: After a successful fistula repair operation, Shamim, 26, is released from a hospital in Qatar. She developed fistula during her first pregnancy at the age of 16. Her difficult labour, assisted only by a traditional birth attendant, ended with a stillborn baby and a fistula. After two other unsuccessful pregnancies, she and her husband now have adopted a baby girl. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Pakistan, 2009.

Two beauty queens on a mission

More global support needed

UNFPA Global Website Obstetric fistula, associated with incontinence and social isolation, is hardly

A report released in October by the United Nations Secretary

glamorous. But two African beauty queens – Miss Ghana@50 and Miss Liberia

General, Mr. Ban Ki-moon, calls for intensified support for cost-

2009 – are using their glamour and recognition to raise awareness about this

effective interventions to address the problem of obstetric fistula.

issue, which affects some of the most marginalized women in their countries. Miss Frances Tekyi Mensah began talking about obstetric fistula through-

The report Supporting Efforts to End Obstetric Fistula says that considerable progress has been achieved in addressing obstetric

out 2007, the 50th anniversary

fistula. The document draws attention to the links between

of her country’s independence,

poverty, income inequalities, gender disparities, discrimination

and the year she reigned as

and poor education, as these factors contribute to poor health in

Miss Ghana@50. And she hasn’t

women and girls. It points out, however, that despite achieving

stopped talking about it since.

some positive developments, many serious challenges remain.

In view of the commitment she demonstrated, the Ghana Government nominated her as

“Obstetric fistula is one of the most devastating consequences Miss Ghana@50, Frances Teyki Mensah, and fistula survivors.

of neglect during childbirth and a stark example of health inequity in the world. Although the condition has been eliminated in the

an Ambassador for Obstetric Fistula. She accepted the mission with a strong

developed world, obstetric fistula continues to afflict the most

drive to make a difference across the country.

impoverished women and girls, most of whom live in rural and

Initially Miss Tekyi Mensah selected obstetric fistula as the project to take

remote areas of the developing world,” the report states.

on during her reign because she realized that it affected the poorest, least

Thoraya Ahmed Obaid, Executive Director of UNFPA, the United

educated and most marginalized women in her country and elsewhere in

Nations Population Fund, has welcomed the new report. In a video

Africa and Asia. “They’ve got nothing except faith and hope and urine-soaked

statement prepared for the recent summit on the Millennium

clothes,” she said of the women who suffer the indignities of fistula. “Some

Development Goals, Ms. Obaid emphasized the importance of

of them claim ‘even death would be better than this.’ If I could help just one

tackling obstetric fistula in line with global agreements to improve

of these women, to me, it is literally, giving that woman her life back.”

the health and rights of women.

Miss Tekyi Mensah spent most of her year as Miss Ghana@50 raising

“Every year millions of women suffer from pregnancy and

awareness about obstetric fistula in the most remote parts of Ghana. She

birth-related complications, as well as injuries. And one of them

met tribal chiefs, religious leaders, opinion leaders, men’s groups and several

is fistula, which is an injury that affects women and leaves

community representatives spreading the message about the importance

them incontinent and thus ostracized from their families and

of prevention and about the possibility of treatment. She also appealed to

communities. By working together we can ensure that fistula

women with the condition to get treatment and raised funds to support the

is something of the past. And we have to restore the dignity of

treatment of about 20 women in the regions she visited. In addition, she

The struggle to improve health-care systems and reduce the rate of maternal death and disability, including obstetric fistula, must not only continue but intensify, as recently published

encouraged 60 other

estimates show that the progress made in maternal mortality

Ghanaians to become

reduction has been slow. Also, there is an urgent need to scale

local advocates. The

up well-known, cost-effective interventions in order to reduce the

group includes fistula

high number of avoidable maternal deaths and disabilities, the

survivors, community,

report points out.

religious and traditional Miss Liberia 2009, Shu-rina Wiah, and fistula advocates.

millions of women,” said Ms. Obaid.

The report cites examples of successful interventions in various

leaders, as well as

countries and calls for specific actions to improve maternal health

men’s groups represen-

and address the issue of obstetric fistula. It also highlights that

tatives and social workers. With the support of the Ghana Ministry of Health,

the condition can be prevented as part of broader efforts made to

the advocates have drawn up action plans, which were implemented in 2010.

achieve MDG 5, the one related to maternal health.

A compelling presentation by Miss Tekyi Mensah at the 2008 Miss World

As part of its recommendations, the document points out that

beauty pageant convinced Shu-rina Wiah, who was crowned Miss Liberia

funding should be predictable and sustained support should be

2009, to take on the issue as her project for the year. Throughout 2009, Miss

provided to countries’ national plans, United Nations entities,

Wiah participated in outreach campaigns to prevent the injury, as well as in

and other global initiatives dedicated to tackling the problem,

projects aimed at empowering survivors.

including the Campaign to End Fistula.

After that, she has frequently spoken to fistula survivors, praising them for their “resilience and courage” in seeking help, and paid tribute to UNFPA for helping to restore respect and dignity to women affected by fistula.



Efforts to end fistula go on despite crisis

Eritrea on the road to be ‘fistula free’

Antananarivo, Madagascar

Asmara, Eritrea The political crisis that

The government of Eritrea, in collaboration with partners, has embarked

began in Madagascar

on a project to make the country ‘fistula free’ by the end of 2011. An

almost two years ago has

intensive campaign to identify and treat women living with obstetric fistula

heavily impacted the imple-

is being implemented in the country. To encourage women to come out for

mentation of assistance

treatment, the Ministry of Health is providing free services and reimbursing

programs in the country

related expenses, such as food and lodging. Also, transportation costs are

and has now taken a toll

being paid for or refunded.

in the fight against fistula.

“It is a government priority to clear the waiting list of existing fistula

Without a formal national

cases in the country, which means that Eritrea would be close to achieving

strategy on the issue or

the national objective of eliminating fistula,” says the UNFPA Representative

even the possibility of

in the country, Mr. Barnabas Yisa.

carrying out major advocacy

Although the number of existing cases in Eritrea is not yet known, teams

projects, most of the activi-

of international experts and national fistula surgeons are working hard to

ties are being implemented

clear the backlog. While the treatment is going on in several health facilities,

by non-governmental

prevention measures are being put in place simultaneously in communities.

organizations and contacts A 17-year-old woman from Madagascar, recently operated upon for fistula, her mother and a fistula specialist. Photo: UNFPA Madagascar, 2009.

The ‘fistula free’

with the government are

initiative is considered


rather advanced in a

“We have faced some

country which has so

technical problems, which hamper the smooth implementation of activi-

many challenges related

ties,” says UNFPA Maternal Health Technical Advisor, Dr. Eugene Kongnyuy.

to the condition of

“However, despite the crisis in the country, we continue to do our work. It

women, such as early

seems like a long time, but we only started the programme in 2008 and,

marriage, low social

even with the crisis, we can see considerable progress.”

status, fewer educa-

Before joining the Campaign to End Fistula in 2008, Madagascar con-

tion opportunities and

ducted a study to assess the magnitude of obstetric fistula in the country.

economic prospects

As part of the findings, the study revealed that knowledge about the

compared to men.

condition among health-care providers was low and that harmful traditional practices contributed significantly to the occurrence of fistula. Rural residence, poverty, lack of education, adolescent pregnancies, a poor referral system and low quality of care during delivery were among the determinants of fistula in Madagascar, the study pointed out. Based on this a set of priorities was identified, including surgical repairs and psychological care, together with social reintegration of fistula patients and fistula prevention. To address these priorities, the programme designed activities to empower women and mobilize community leaders. Since joining the Campaign, the country has introduced the activities

Besides the high Ms. Yirgalem Isaac, nurse midwife in charge of the fistula ward at the Mendefera hospital with a patient. Photo: UNFPA Eritrea, 2010.

number of maternal deaths —280 per 100,000 live births, according

to the most recent UN estimates— Eritrea also faces a high number of births carried out without the support of a skilled health professional, reflecting some reluctance to seek adequate health care during childbirth. “Culture and tradition can explain this reluctance to deliver with skilled birth attendants. Such practices increase the risk of complications, maternal death and disability,” explains the Campaign Coordinator, Ms.

in phases. Currently six reference hospitals are involved in surgical repair

Gillian Slinger. “We also need to think very carefully about how to tackle

while six NGOs are undertaking social reintegration of fistula survivors and

these challenging issues.”

prevention of obstetric fistula using successfully repaired patients as role models and advocates. “We try to ensure that providers are able to properly handle emergen-

Eritrea joined the Campaign to End Fistula in 2003, when a needs assessment was carried out to detect the magnitude of the disability at national level. Since then, obstetric fistula has been addressed as part of a

cies. This is another aspect of prevention that complements community

comprehensive package of interventions to overcome the serious reproduc-

sensitization with former fistula patients.”

tive health problems faced by the country, including an agreement with

When asked if he believes that the Campaign will continue in

Stanford University to provide technical assistance for on-the-job training of

Madagascar, Dr. Kongnyuy is firm: “We have many accomplishments to

local surgeons and midwives, specialized care for complicated cases, trainee

celebrate, including the de-stigmatization of fistula. We’ll just continue to

follow-up and community mobilization design, monitoring and evaluation.

scale up our activities and develop a national obstetric fistula strategy as soon as the socio-political situation improves. We are not adrift.”


Read more:

Professionals trained to deal with fistula

Pioneer struggles to tackle fistula

Karachi, Pakistan

Conakry, Guinea

A new programme initiated by UNFPA in Pakistan is providing a 30-week training course for community midwives on fistula prevention and treatment. The programme, which already benefited more than 70 midwives, has been developed to train trainers, help prevent obstructed labour and provide quick referral when emergency obstetric care is needed. According to experts, having more midwives in the communities will also help raise awareness among women about the importance of spacing births, seeking skilled attendants at the time of delivery and providing proper nutrition for pregnant girls and women. One of the lead fistula surgeons in the country, Dr. Shershah Syed believes that more health professionals should be trained to help improve maternal health. “We don’t have enough skilled birth attendants. Moreover, some of the existing attendants are improperly trained,” says Dr. Syed. The initiative to train community midwives complements a broader

Women gathering at the village of Bate Nafadji to hear an educational talk on fistula organized by a local NGO, the African Family Support. Photo: UNFPA Guinea, 2010.

One of the first countries to join the Campaign to End Fistula in 2003, Guinea

strategy to build capacity to treat fistula, developed and implemented

is still struggling to tackle obstetric fistula. With a population of 10 million and

since January 2006, when the Campaign to End Fistula was launched in

24 ethnic groups, the country faces one of the highest maternal death ratios in

Pakistan. As part of the strategy, Pakistani doctors have been encour-

the African continent —680 per 100,000 live births— and has not yet been able

aged to exchange knowledge and share experiences with internationally

to establish a coordinated response to disabilities such as fistula.

renowned surgeons in the field of obstetric fistula. “Our surgeons are having more opportunities to learn about cost-

“This has been a long-lasting fight,” explains the chief of the Ministry of Health Division for Reproductive Health in Guinea, Dr. Madina Rachid. Following

effective surgical interventions that can be used to repair fistula patients,”

the International Conference on Population and Development held in 1994,

tells Dr. Faaria Ahsan, UNFPA’s Reproductive Health and Fistula specialist in

Guinea, as well as other developing countries, convened a national forum,


which defined the elements of reproductive health that should receive priority

Since the launch of the Campaign in the country, more than 38 surgeons have been trained on fistula repair surgeries, and an estimated 78 com-

in the country. “Back then, obstetric fistula had been already identified as a central

munity midwives and nurses have been trained on pre- and post-operative

component of maternal health in Guinea. However, despite the inclusion of

management of obstetric fistula. Currently, seven regional and six referral

the condition in the national health policy and programs, little effort had

centres are providing free services to women in need; more than 2,000

been made to tackle the problem in the country,” says Dr. Rachid.

fistula cases have been repaired with a success rate of 90 per cent.

After an awareness campaign launched in 2003, the Ministry of Health conducted a situation analysis in collaboration with UNFPA, leading to the establishment of a project for the prevention and treatment of obstetric fistula in Kankan, Guinea’s largest city. Since then, the project has allowed for the training of health professionals and community workers and the promotion of public awareness on how to prevent fistula, including messages disseminated through public and private radio stations in urban and rural areas, as well as through peer educators. More than 110 surgical repairs have been successfully carried out thus far and 29 fistula survivors have received training on income-generating activities in the country. However, despite the results achieved and lessons learned, many challenges remain, including the lack of skilled human resources, insufficient treatment services and low utilization of health services by the community. “Most of all, we need a strong national leadership to establish a coordinated response and to strengthen partnerships. With that we can perhaps

Students from the Nursing and Midwifery Tutor Training course during their graduation ceremony. They completed a 30-week course that aims to ensure more qualified midwives and nurses, who can then teach other professionals and thus provide better care. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Karachi, Pakistan, 2009.

foster changes in society and promote the de-stigmatization of fistula,” says the UNFPA Representative in Guinea, Dr. Marcelle Chevallier.

Read more:



Fistula survivors meet the Danish Crown Princess

Congressional briefing discusses fistula

Washington, D.C., U.S.A.

During the same week the Women Deliver Conference was held, fistula survivor and advocate Sarah Omega had the opportunity to brief

One of the highlights of the Women Deliver

members of the U.S. Congress on issues related to obstetric fistula.

Conference in Washington D.C. in June 2010 was the meeting between Her Royal

The briefing was organized in coordination with the offices of U.S.

Highness Crown Princess Mary of Denmark,

Representatives Carolyn Maloney, from New York, and Mike Castle,

and two fistula survivors and advocates.

from Delaware, sponsors of a bipartisan legislation on fistula: The

The Crown Princess, who was accompanied

Obstetric Fistula Prevention, Treatment, Hope and Dignity Restora-

by the Danish Minister for Development

tion Act of 2010, H.R. 5441.

Cooperation Søren Pind, was deeply moved by their stories.

Ms. Awatif Altayib. Photo: Moises Saman/Panos, 2010.

One of the women the Crown Princess

Earlier in the same week, Sarah Omega also participated

met was Ms. Sarah Omega, a fistula survivor from Kenya, who became

in an advocacy effort on Capi-

pregnant in her late teens. After hours of obstructed labour and losing her

tol Hill, aimed at encouraging

baby in the process, she developed a fistula —a condition she then lived

U.S. funding and support for

with for 12 years before receiving treatment. Since 2007 Ms. Omega has

maternal health and MDG 5.

traveled Kenya and the world as a maternal health advocate. She wants to

Ms. Omega, who was joined

ensure that other women with fistula know that treatment is available.

by television and film star

“In Kenya, it is estimated that we have 3,000 new fistula occurrences each year, but only 7 per cent of these women get treatment, leaving us with a huge backlog of cases. For this reason,

Ms. Jennifer Beals, shared her personal story with several representatives.

UN Foundation representative Tamara Kreinen, fistula survivor and advocate Sarah Omega, Rep. Mark Kirk and television and film star Jennifer Beals. Photo: Sam Hurd, Women Deliver, Washington, D.C., 2010.

I have been going to the communities, getting women who are suffering in silence and refer-

Read more:

ring them to a health facility where they can receive treatment,” Ms. Omega explained. Ms. Awatif Altayib, the other advocate who met the Crown Princess, came from Ms. Sarah Omega. Photo: Moises Saman/Panos, 2010.

Toolkit promotes advocacy on fistula

Furbaranga, West Darfur State, Sudan, where

As part of the fistula-related events during

she works as the village midwife. Also a

the Women Deliver conference, UNFPA and

fistula survivor, she was married and pregnant

Family Care International (FCI) launched

with her first child at the age of 16. Sadly, her baby did not survive an

a new advocacy publication and interac-

obstructed labour, from which she developed obstetric fistula. Determined

tive CD-ROM Toolkit – Living Testimony:

to ensure that other women do not suffer as she had, Ms. Altayib decided

Obstetric Fistula and Inequities in Maternal

to become a midwife. She now recruits women living with fistula and

Health. The publication aims to contrib-

helps them access the care they need.

ute to broader efforts to reduce maternal

“It was an important opportunity for me to learn more about the

mortality and morbidity, to bring obstetric

maternal health challenges that persist in the developing world. Sarah and

fistula to the fore, and to highlight specific actions to reduce its

Awatif lent a face to all women who have suffered due to the lack of access

incidence and prevalence.

to skilled attendants during pregnancy and childbirth. This is something industrialized nations take for granted but is still very much a luxury in many countries in the developing world,”

The main objectives of the CD-ROM Toolkit are to: •

said the Crown Princess of Denmark.

Provide guidance and tools to carry out advocacy for improving maternal health, and to highlight how attitudes about

During the meeting, Ms. Thoraya Obaid,

pregnancy and delivery affect maternal death and disabilities,

UNFPA Executive Director, expressed her

including obstetric fistula.

sincere appreciation that the Crown Princess

Present new strategies for addressing the social norms and

accepted to be patron of UNFPA. The

cultural practices that impede access to sexual and reproduc-

announcement made in June 2010 called

tive health-care services in order to increase their availability.

attention to Denmark’s support of UNFPA’s efforts to promote maternal health and safer motherhood in developing nations.


H.R.H. The Crown Princess of Denmark. Photo: Steen Evald, 2010.

For additional information or to obtain copies of the CD-ROM Toolkit, contact: or

A fistula champion and a pioneer

Campaign has new coordinator

Yaoundé, Cameroon Dispatch interviewed Dr. Pierre Fouda, one of the pioneers of fistula treatment in Cameroon. A urologist and long-term partner in the country, Dr. Fouda talks about the challenges of fighting fistula.

Gillian Slinger, a British-trained nurse and midwife with a BSc Degree in Health Management and an MSc Degree in Public Health, recently joined UNFPA to coordinate the global Campaign to End Fistula. As a midwife, Ms. Slinger has always been deeply moved by the

Dispatch: How did obstetric fistula come to be a priority health issue in Cameroon? Dr. Fouda: In 2004, Cameroon recorded particularly alarming indicators of maternal health.

Dr. Pierre Fouda. Photo: UNFPA Cameroon, 2010.

many obstetric fistula cases she has cared for in the field. Since starting her MSF post in Geneva in 2007, her involvement in fistula work has increased enormously, fueling her commitment to address global maternal death and disability. Asked about her plans for the future, Ms. Slinger talks about a new vision for the Campaign. “There will be a gradual scaling up of training and treatment

It was thus legitimate to think

services in response to the significant number of existing cases, with

that, despite the absence of

a shift away from ‘vertical’ fistula campaigns organized as occasional

data, obstetric fistula was a

interventions, and towards more permanent fistula services,” explains

reality in Cameroon. A few

Ms. Slinger.

years ago, UNFPA supported the

According to Ms. Slinger, the idea is to promote a more holistic

Ministry of Public Health to evaluate the situation in two provinces (North

approach to services, as they will be incorporated into existing health

and Far-North). This study allowed us to gain basic knowledge of the fistula

structures and firmly anchored in sustainable health programmes at

situation in that part of the country, to learn that there are a lot of cases in

the national level. “There will also be greater emphasis on prevention,

these regions and to realize that the existing health facilities did not have

including the work with maternal health partners and looking at

the capacity to deal with the problem.

preventive measures immediately after prolonged labour and for new fistula cases,” she complements.

Dispatch: Can you share with us some of the challenges related to obstetric fistula that you have faced in the country? Dr. Fouda: There are many. To begin with, how can we eliminate stigmatization? You can see these women abandoned by everybody, and rejected by the community because their condition is seen as a “curse” or result of infidelity. They are considered shameful and forced to live apart from the community, all the while mourning their babies who have died. Raising funds is another challenge. Women usually cannot pay for the services

As part of the new vision that is emerging, a greater focus on quality, more research —including on the reintegration of recovering fistula patients after treatment— and improved communication channels will also be integral to the Campaign, Ms. Slinger says. “One of the expected outcomes is a greater information flow from global to project level and vice versa, and between key practitioners and organizations working together to move this agenda forward as part of the well-established partnership spirit of the Campaign.”

because they are extremely poor. The exclusion of the community is not only social and cultural, but also economic. And since we don’t have the means and resources for everybody yet, their treatment is not possible without foreign support. There are also the difficulties involved in following the patients who have been operated on once they return to their villages, since most of them are from remote areas where even motorbikes cannot get to, especially during the raining season. Another issue is the social reintegration of the patients into their communities. We also need to improve our health system, and the occurrence of obstetric fistula is an indicator of that. It means training health professionals in the management of obstetric fistula, which is another challenge. Finally, treating obstetric fistula is good, but prevention is even better. Sensitization has to continue, but it also needs to be improved. It should never be forgotten that it is the man who makes decisions in African society, and that he is generally under the influence of his community when he makes his decisions. Read the full interview online.

Read more:

Gillian Slinger, the new Coordinator of the Campaign to End Fistula, with a fistula survivor in the market close to the Kamuli Mission Hospital in Uganda. Photo: Brian Hancock, FRCS, founder Uganda Childbirth Injury Fund, 2010.



The Third Annual

ISOFS started from the recognition among prominent fistula surgeons working in Africa

Conference of the

and Asia that there are more than two million obstetric fistula survivors in the world,

International Society

yet there are not enough skilled surgeons to operate on them. According to specialists,

of Obstetric Fistula

surgical attempts by inexperienced surgeons can lead to further damage to the women

Surgeons (ISOFS) will take

living with fistula.


place in Dakar, Senegal, from 7-9 December 2010.

The previous conference, held in Nairobi, Kenya, in 2009, covered topics ranging from the

As an annual summit of

role of community midwives to the effectiveness of social reintegration and community

health-care providers and

partnerships. Organized in collaboration with the African Medical and Research

activists from some of

Foundation (AMREF), the event hosted a diverse assembly of government ministers,

the world’s most affected

medical professionals, and delegates from charitable and aid organizations and academic

nations, ISOFS provides a

institutions. In 2010, the organizing institutions expect an even larger participation.

valuable forum to share

Third Annual Conference of the International Society of Obstetric Fistula Surgeons (ISOFS) Annual Meeting of the International Obstetric Fistula Working Group (IOFWG)

key lessons from the

Immediately prior to the conference, on 5-6 December, obstetric fistula specialists

work on the front lines of

from various countries will gather in Dakar for the International Obstetric Fistula


obstetric fistula.

Working Group (IOFWG)* annual meeting. They will discuss priorities and exchange

Both the IOFWG meeting (5-6 Dec) and the ISOFS conference (7-9 Dec) will be held at the Hotel Des Almadies in Dakar, Senegal.

experiences in the field of obstetric fistula. *Among its many partners at international, national, regional and local levels, the Campaign to End Fistula also counts on the support of the many institutions and practitioners who are part of the International Obstetric Fistula Working Group (IOFWG). The group aims to ensure global collaboration and coordination of efforts for all issues relating to fistula, including prevention and management, and to guide the secretariat of the global Campaign. Learn more online.

Why the Campaign? 10–15 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. The Campaign is now present in 49 countries, having raised over $40 million toward the goal of eliminating fistula. 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 or to learn how you can help, please visit: 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 Republic Liberia Cameroon Ghana Benin Somalia Uganda Togo Congo Kenya Equatorial Gabon Democratic Guinea Rwanda Republic Burundi of Congo United Republic of Tanzania Angola

Zambia Malawi Zimbabwe





South Africa


Campaign to End Fistula countries

UNFPA Campaign to End Fistula

605 Third Avenue, New York, NY 10158 email: dispatch is a biannual newsletter highlighing developments in the Campaign to End Fistula Editorial Process: Etienne Franca Design and Printing: Prographics, Inc.

Disclaimer: The opinions expressed by the persons interviewed do not necessarily reflect the newsletter editorial position or the official position of UNFPA.

Contributors: Faaria Ahsan, Yves Bergevin, Luc de Bernis, Nicole Carta, Marcelle Chevallier, Cheikh Tidiane Cissé, Sarah Craven, Akinyele Eric Dairo, Apollinaire Delamou, Triana Dorazio, Nicole Eteki, Pernille Fenger, Calixte Hessou, Sennen Hounton, Esther Huerta, Katja Iversen, Patricia Keba, Hugues Kone, Eugene Kongnyuy, David Lawson, Bunmi Makinwa, Emilie Maurice, Elsabeth Mengsteab, Robert Mensah, Aline Piedecocq, Shafia Rashid, William Ryan, Cecilia Schubert, Alain Sibenaler, Klaus SimoniPedersen, Sandy Singer, Gillian Slinger, Kadiatou Sy, Etta Tadese, Margherita Tinti, Barnabas Yisa. 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. Our appreciation is also extended to the many partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.

Dispatch November 2010  

Campaign to End Fistula - Dispatch, November 2010