Empowering Obstetric Fistula Survivors in Uganda
How Amref is helping Obstetric Fistula survivors to rebuild their lives after living with Fistula
Obstetric fistula is one of the most serious complications that can occur during childbirth. It is a pregnancy-related condition that develops during prolonged or obstructed labour, causing continuous leakage through an abnormal opening between a woman’s urinary tract and/or rectum and the vagina (WHO 2018).
Uganda has the third highest prevalence of fistula in the world,
The dangers of fistula
In Uganda, obstetric fistula has been described as a “silent morbidity” among Ugandan women. After a series of reports in 2005 it was revealed that Uganda had the third-highest prevalence of fistula in the world, due to a combination of factors: rapid population growth; limited access to healthcare information and services; poverty.
The Uganda Demographic and Health Survey’s most recent official estimate (2016) was that 200,000 women live with obstetric fistula in Uganda today, and a further 1,900 new cases occur every year. Only 3% of those women living with obstetric fistula are estimated to have sought care. (2016 National Obstetric Fistula Strategy)
Amref Health Africa began a programme to empower fistula survivors in the West Nile Region of Uganda in 2019. By the end of its first phase in 2022, the project reached 415 women and girls with a holistic package of life-changing restorative surgery, psychosocial support (PSS) and livelihoods opportunities that have facilitated their reintegration into their communities, increased their mental resilience and ability to provide for themselves and their families.
The programme was met with challenges from 2020 to 2022 because of the COVID-19 pandemic, which exacerbated the burden on maternal health services in the West Nile Region. Health workers and resources were reallocated to respond to the pandemic, and restrictions on public gatherings meant that health workers and community advocates were unable to engage with communities and raise awareness of fistula and other health services. Communities themselves were less likely to seek professional medical care in health facilities out of fear of being infected by the COVID-19 virus.
All of these factors together, with the addition of extremely limited health resources and capacity, meant that access to reproductive, maternal, neonatal, child and adolescent health (RMNCAH) services was significantly reduced. Antenatal appointment attendance and health facility-based deliveries also fell sharply, and teenage pregnancy rates increased by 17% in Uganda, increasing the risk of pregnant women developing obstetric fistula – especially as younger women are more at risk of developing the condition.
Living a dignified life after Fistula
In November 2022, Phase 2 of this work began which aims to reach 1,080 women in the West Nile Region of northern Uganda over three years. This will include clinical treatment – reconstructive surgery, livelihoods and psychosocial support (PSS) post-surgery to support survivors to successfully rebuild their lives after periods of social exclusion. Surgery is transformative, but it’s only one element of the support survivors require after such a traumatic experience. Our holistic approach considers the many aspects of survivors’ identities & the multiple roles they play in their families and communities – and the impact that living with fistula can have on their different lives. Many suffer from serious social exclusion and need support to rebuild their lives, confidence, and independence as well as reconstructive surgery.
Additionally, in Phase 2 we will support the region’s first obstetric fistula survey to help health authorities plan for quality fistula services in the long-term, involving the Ugandan Ministry of Health. These new activities will ensure we are working with local and national government to demonstrate the demand that exist at the community level, and to help them to plan better and allocate appropriate resources towards achieving long-term decreases in fistula levels across Uganda.
All images (c) Edina Kalikali for Amref Health Africa