For These Women, Survival Is Just the Start

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Fistula Care Plus and other USAID-supported projects have repaired over 50,000 fistulas around the world. / Amy Fowler, USAID
Fistula Care Plus and other USAID-supported projects have repaired over 50,000 fistulas around the world. (Amy Fowler, USAID)

For These Women, Survival Is Just the Start

More than two million women in sub-Saharan Africa and Asia are estimated to be living with fistula, and an estimated 30,000 to 100,000 new cases develop annually. Yet the condition is almost entirely preventable, and its continuance is a sign of inequality for the world’s most vulnerable women and girls.

USAID is restoring a sense of empowerment in these women and girls who are survivors of tribal, class, and caste prejudice. After nearly 15 years of fistula work, USAID is excited to acknowledge a number of historic results and milestone accomplishments by celebrating the people our work empowers.

What Is Obstetric Fistula?
Obstetric fistula is an injury caused by prolonged labor without medical intervention or cesarean section. A fistula is a hole that develops between the birth canal and one or more of a woman’s internal organs, and results in chronic, uncontrollable leakage of urine and/or feces.

Obstetric fistula is most common among young women experiencing their first pregnancy, particularly in regions where early marriage is the norm, and with adolescent girls whose pelvises are not yet fully developed. However, it can occur in older women and those who have successfully given birth previously.

Midwives in Nigeria help women deliver safely by identifying danger signs that can lead to fistula. / Fistula Care Plus

Midwives in Nigeria help women deliver safely by identifying danger signs that can lead to fistula. (Photo courtesy of Fistula Care Plus)

Fistula can be prevented by access to voluntary family planning services to help families have children at the healthiest time for mother and child. Accessible, safe delivery care is also critical to prevent fistula in women with prolonged, obstructed labor.

Obstetric fistula sufferers often face abandonment by their husbands and social isolation from their families and communities because of the perpetual odor and social stigma.

It’s a horrendous disability, and many women become demoralized and give up on health services. We’re working to reduce the stigma and teach more surgeons how to perform this procedure.

USAID’s Work to Address Fistula
USAID has invested more than $128 million to support fistula patients since 2004, restoring dignity to women’s lives and strengthening fistula prevention.

Through the USAID-funded Fistula Care Plus project, we are working through an integrated approach to strengthen health systems in sub-Saharan Africa and South Asia to prevent, detect and treat fistula and to reintegrate patients into their communities. Through accessible, skilled maternity care and family planning services, obstetric fistula can become a rare event for future generations.

“If you have this problem, you can go to Kagando and they will help you like they helped me.”

Until August 2013, the recovery period in hospital for women who underwent fistula repair surgery was up to one month, mainly due to catheter tubes that are left in place to help drain urine. However, a USAID study following an eight-country trial concluded that short-term bladder catheterization of seven days could yield similar results to long-term catheterization of 14-plus days.

The study also concluded that short-term catheterization is safe and effective for care of women with simple fistula. A shorter catheterization period means women can go home to their families sooner, which, in turn, reduces service costs, increases patient comfort, and allows more women to be treated at facilities limited by bed space without compromising quality of care.

After suffering from fistula for 15 years, Chandana received repair surgery at a USAID-supported facility in Bangladesh. / Amy Fowler, USAID

After suffering from fistula for 15 years, Chandana received repair surgery at a USAID-supported facility in Bangladesh. (Amy Fowler, USAID)

Following the results of USAID’s groundbreaking study, in January 2018, the World Health Organization (WHO) issued a new recommendation on the duration of catheterization recovery after fistula repair surgery. The new guidance recommends seven to 10 days of catheterization for complete healing.

Over 50,000 fistula repairs have been supported through Fistula Care and other USAID-supported projects. / Fistula Care Plus

Over 50,000 fistula repairs have been supported through Fistula Care and other USAID-supported projects. (Photo courtesy of Fistula Care Plus)

Only a few weeks before WHO released its new guidelines, USAID reached a milestone achievement in our fistula care work. As of December 31, 2017, USAID has supported 50,124 fistula repairs.

Reaching that number of fistula repairs is an extraordinary accomplishment in USAID’s history, and would not have been achieved last year without the integrated global health network behind the numbers. Behind these 50,000 repairs is 14 years of USAID leadership, more than 100 improved facilities, 16 country programs, more than 420,000 family planning counseling sessions provided at supported sites in just the last fiscal year, and thousands of USAID-trained medical personnel and volunteers.

We’re proud to acknowledge this achievement by celebrating the women and men who advocate and care for the women with obstetric fistula  -- and the women affected by fistula who have been empowered by our work. Women like Jane  -- a survivor who now owns her own business in Uganda.

Jane Heals

From Jane’s entrepreneurial goals and courageous spirit, an outsider would never guess how far this former fistula sufferer has come. Jane overcame abandonment by her husband, a childbirth-related injury, and social stigmatization by her community, but now is a hopeful small business owner and mother of four.

After Jane’s fistula repair surgery at Kagando Mission Hospital, a USAID-supported hospital in southwestern Uganda, she was completely healed. “I feel good now because I no longer sleep in a wet bed and I can sleep till the morning because I am no longer wet,” she said.

Once she was healed, Jane decided to start a small business selling food in the market. She now encourages other Ugandans with fistula to seek treatment: “If you have this problem, you can go to Kagando and they will help you like they helped me.”

Survival is just the start. We have to support and empower women to achieve not only good physical and mental health, but also to take direction of their own lives.

About the Author: Mary Ellen Stanton is a Senior Maternal Health Adviser at USAID and passionate midwife. She has practiced nursing and teaching in a variety of settings, including New York City, rural Kentucky, a Biafran refugee camp, Costa Rica, the Ivory Coast, Swaziland and India.

Editor's Note: This entry originally appeared in USAID's 2030: Ending Extreme Poverty in this Generation publication on Medium.com.