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[ACCRA] A centre of excellence is urgently needed in Africa to train healthcare professionals and treat women suffering from obstetric fistula, a study says.

The centre of excellence, according to the research, will train and make available gynaecologists for interventions in obstetric fistula repairs, especially in rural settings.

Obstetric fistula, a devastating childbirth injury caused by obstructed and delayed labour, is an abnormal opening between a woman's genital and urinary tract or rectum that causes uncontrollable leakage of urine or faeces.

According to the World Health Organization (WHO), over two million young women are living with untreated obstetric fistula in Asia and Sub-Saharan Africa, and addressing it could contribute to the Sustainable Development Goal of improving maternal health (Goal three).

Published in the March issue of Midwifery, the study involved interviews with 32 women aged 21 to 70 years old who were living with the medical condition, and calls for increased attention to address the problem in Africa.

“If policymakers are able to identify that obstetrics fistula is a problem in Ghana, they will be able to address it.”

Rose Mantey, Mercy Women's Catholic Hospital and Obstetric Fistula Centre

“A national and international coordinated approach from agencies ...could prevent more cases from occurring,” says Rose Mantey, the study's lead author and a midwife at Ghana-based Mercy Women's Catholic Hospital and Obstetric Fistula Centre, where the study was conducted. “A good example of a well-coordinated multi-agency approach is in Addis Ababa, Ethiopia, where ... women have been rehabilitated back into their communities and provided with jobs.”

A well-coordinated approach, she tells SciDev.Net, means more education opportunities for front-line workers, additional funding from different agencies to support infrastructure and equipment development, and budget for maternal and newborn health service with good quality control and family planning services.

Mantey adds that many women with the condition face stigma, isolation, rejection from family and society, economic and social challenges, poverty, increased risks of spontanous abortion and suicidal thoughts.

“For 20 years now, I have been suffering from this condition and at my age, I still do not have a child,” a 43-year-old woman was cited in the study.

“It has even affected my mother's business so she has now moved to a different community in order to sell her fish so that she will be able to support my siblings and me,” she adds.

Mantey explains that the reasons for the increase in number of obstetric fistula in Africa include poverty, the preference of women to give birth in prayer camps rather than in hospitals, and the influence of families and in-laws on women seeking care.

“Women are also not always allowed to ask for medical care because families and in-laws prefer to keep it as a secret,” Mantey explains.

According to Mantey, it is necessary for African countries to generate more data on obstetric fistula to help policymakers and key institutions to address.

“If policymakers are able to identify that obstetrics fistula is a problem in Ghana, they will be able to address it," explains Mantey, adding that there is a need for increased awareness of the disease among healthcare professionals and the public.

Kate Grant, the chief executive officer of the Fistula Foundation, says that the study offers a qualitative perspective from a limited sample size, and may be a promising basis for future quantitative research.

“The Institute for Health Metrics and Evaluation estimated in 2017 that the burden of living with obstetric fistula is comparable to living with terminal cancer, and double the burden of blindness,” Grant explains.

“We are on track to heal our 50,000th fistula patient this spring. Only ten years ago, we were supporting just one hospital in Ethiopia,” Grant adds.

The Fistula Foundation has been supporting treatment partners in more than 20 countries in Africa and Asia including Bangladesh, Kenya, Tanzania and Zambia, according to information on its website.
Grant bemoans the dearth of quantitative data on obstetric fistula despite its negative impacts on women. “I think this lack of data goes back to fistula’s causes: poverty and gender discrimination. The condition affects some of the most marginalised people on the planet, and not many leaders in power are stepping forward to intervene on their behalf,” Grant says.

“Another serious barrier is that fistula is much more likely to affect rural women who lack access to emergency — or even basic — obstetric care. If women are hard to reach, they are hard to study,” Grant adds.
 
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


References

Rose Mantey and others Womens’ experiences of living with obstetric fistula in Ghana–time for the establishment of a fistula centre of excellence (March 2020)

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