Niger’s ten years of engagement in the fight against obstetric fistula has borne fruit, concluded a workshop held from 8 to 10 October 2013 in the capital Niamey. Organized by UNFPA, the United Nations Population Fund, the even gathered more than 70 health professionals and partners working to end obstetric fistula in several countries. Fistula focal points from UNFPA country offices in the Central African Republic, Chad, the Democratic Republic of the Congo and Mauritania also participated in the workshop to learn from Niger’s rich experience in addressing obstetric fistula, and to improve south-south cooperation.
A cornerstone of fistula response in Niger was the creation of a network that brings national and international stakeholders around the table to discuss challenges and plan for action.
“In general, obstetric fistula touches poor, illiterate and rural women. Due to its dehumanizing consequences, fistula constitutes a public health problem to which Niger has responded by creating the REF—Réseau d’Eradication de la Fistule [Network to Eradicate Fistula]—which gathers all partners in this fight and enables the group to achieve concrete results,” Niger’s Minister of Health Mano Aghali said at the opening of the event.
Minister of Health Mano Aghali (c.) chairs the opening session of the workshop; Monique Clesca, UNFPA Representative in Niger (l.); Gillian Slinger, Coordinator of the Campaign to End Fistula (r.) Photo: UNFPA.
Monique Clesca, UNFPA Representative in Niger said the UN agency has mobilized partners in the country to create the REF around the Ministry of Health. Since 2004, UNFPA has always been an active partner in the fight against fistula in Niger, supporting treatment for about 70 per cent of fistula cases cases identified in the country. Until 2010, UNFPA was the only financing partner for social reintegration activities.
To address the complex problem of fistula, Niger has implemented a strategy based on the three pillars of prevention, medical treatment and reintegration of women into society and the labour market.
Prevention is paramount as obstetric fistula is a direct consequence of poor access to health services during pregnancy and childbirth The REF has carried out numerous community-based activities to increase prevention, such as initiating and supporting community radio stations and women’s associations, operating awareness raising caravans and screening films in villages and towns.
Since 2005, 1,577 women cured from fistula have been trained as community focal points for local awareness raising. “The assignments of cured women constitute a very important strategy as these actions enable communities to understand fistula and show them that fistula is not inevitable but a curable disease,” said Ms. Moussa Mariama, fistula focal point at the Ministry of Health.
Aissa Boubakar (l.) and Roukaya Oumarou told their story (Photo: Monique Clesca/UNFPA)
Part of the prevention activities is to address child marriage and avoid adolescent pregnancy. Physically immature first-time mothers are at increased risk for prolonged, obstructed labour, which may result in obstetric fistula, especially if an emergency Caesarean section is unavailable or inaccessible. In Niger, the average age at the first marriage is 15.
“I wish to launch an appeal to our parents to stop marrying their girls so young. For me, under the age of 18, a girl should not be married,” said Aissa Boubakar, fistula survivor, 26, after telling her story at the opening of the workshop. She was married at the age of 14. Her fistula, developed during her first childbirth, was repaired only after eight surgeries.
“I will now return home and continue testifying. Some women hide. They don’t know what they have and that they can be treated,” concluded Ms. Boubakar.
“I never heard about this condition before. Urine didn’t stop leaking. I was ashamed,” noted Roukaya Oumarou, 25. She developed obstetric fistula after a difficult delivery three years after getting married. She was 18. “I was really scared, but it is important to testify because I know that this can save the lives of other girls,” Ms. Oumarou said.
Fistula repairs free of charge
Medical treatment of women living with fistula is on the rise in Niger. “Everything has changed: taking charge of women living with fistula is now better organized, coordinated and decentralized thanks to the establishment of six treatment centres in the country. Between 2005 and 2012, more than 3,000 women have been treated,” said Dr. Mahaman Tassiou, surgeon at Lamordé Hospital in Niamey. “In addition, patients don't have to pay anything, it’s for free, from admission to discharge,” Dr. Tassiou added.
The workshop encouraged the expansion of this scheme and the establishmetn of new treatment centres in Diffa, near the border with Nigeria, and in Agadez, in central Niger, as well as follow-up investments for reintegration, training and research. The workshop also recommended taking into account the psychological dimension when caring for women living with fistula.
First Lady of Niger, Dr. Malika Issoufou Mahamadou, meets UNFPA delegation (Photo: UNFPA)
Aftercare is key
The reintegration into communities and the labour market is a crucial part of the country’s strategy to tackle the condition, which marginalizes so many women in Niger. The workshop recommended reinforcing social and medical care not only immediately after surgery, but also during all future pregnancies of fistula survivors as they need to plan for Caesarean sections in order to ensure safer childbirth.
Thanks to local associations, cured women receive business training, which allows them to generate an income when they return to their communities. Fistula survivors also receive a $100 loan to start a business. With UNFPA support, more than 1,750 women have been reintegrated since 2005.
The workshop highlighted two new approaches to reintegration. The Danja Fistula Centre, opened in 2012 by the Worldwide Fistula Fund, a partner organization in the Campaign to End Fistula, helps fistula survivors become part of community business. The micro-finance institution Asusu, in Niamey, integrates cured women into a village group.
The workshop recommended that these initiatives be included into the current national strategy to fight fistula. The workshop also encouraged a pilot programme to provide mobile phones—along with solar panels to recharge batteries—to fistula survivors to facilitate keeping in contact with them and to ensure their well-being after they return home, as well as in any future pregnancies.
Fistula patients proudly showing their mobile phones at the National Reference Centre for Obstetric Fistula in Niamey (Photo: UNFPA)
“I am sure that the gains made will be consolidated and that civil society will continue to mobilize support. I am also certain that the solidarity from partners and donors will increase,” said UNFPA Representative Monique Clesca.
“The workshop has developed a vision for continuing the fight against obstetric fistula in Niger, with a special focus on aftercare for survivors of this tragedy,” stressed Gillian Slinger, Coordinator of the global Campaign to End Fistula Campaign.
“Fistula is a neglected public health and human rights issue. While Niger is making good progress in prevention and management of the condition, more expert fistula surgeons and health personnel are urgently required to treat the backlog of cases, and to ensure full recovery and long term well-being of affected women following treatment,” concluded Ms. Slinger.