The Fight Fistula! Campaign, initiated under the German Foundation for World Population's (DSW) Youth-to-Youth programme, intends to reach both men and women in East and West Gojam in Ethiopia. The project uses trained nurses and former fistula sufferers, who are trained as peer educators, to reach people in the region with reproductive health information and improved health facilities. The project involves home-to-home visits, peer-to-peer learning in youth clubs, and mass edutainment.

Communication Strategies: 

As the campaign is based on the idea that prevention is the key to fighting fistula, the campaign's main strategies are to promote awareness of fistula and improve family planning services. The organisers believe that peer-to-peer communication, supported by the provision of good health services, can be an effective way to encourage young women to take control of their sexual and reproductive health, thereby preventing incidences of fistula.

The campaign uses peer education as a means to engage young people and trains former fistula sufferers to conduct home visits and raise awareness about reproductive health issues through youth clubs. At the same time, the training of former fistula patients aims to assist in their reintegration, help reduce stigma by normalising the condition, and give other members of the youth clubs the opportunity to talk openly with someone who understands their concerns and experiences.

As part of the project, DSW is also working to increase the organisational and management capacity of 15 youth clubs that focus on young women. This includes establishing a referral system between youth clubs and health facilities to help improve access to reproductive health services. Local nurses, who have been trained on the treatment of fistula, liaise with the youth clubs, provide counselling services, and educate the community (notably, parents and religious leaders) about topics linked to the prevention and treatment of fistula.

Through the mass edutainment aspect of the campaign, the project aims to engage a more diverse and wider audience than can be reached through the youth clubs. According to the organisers, the youth clubs are using folk media methods - including music, dance, and drama - to promote social values, raise awareness, disseminate information, provide role models, and encourage positive attitudes and behaviour change.

Development Issues: 

Women, Reproductive Health, Maternal Health, Youth.

Key Points: 

Fistula is a childbirth injury that can leave women incontinent, ashamed, and ostracised from society. An obstetric fistula is a hole, caused by prolonged obstructed labour, leading to damages to the tissues of the vagina, the bladder, and rectum. Apart from leaving women incontinent, women may also suffer nerve damage to lower extremities after prolonged labour in a squatting position and significant emotional damage from both the death of the baby, which happens in most cases, and the stigma that accompanies fistula.

DSW says that in Ethiopia alone there are an estimated 100,000 women suffering with untreated fistula, either due to lack of awareness or shame derived from social stigma. Each year, another 9,000 women develop fistula, representing the highest prevalence of fistula worldwide. Fistula occurs disproportionately among impoverished girls and women, especially those living far from medical services. The Fight Fistula! campaign aims to reach an estimated half a million people in the region.

Partner Text: 

Addis Ababa Fistula Hospital and DSW.


Youth to Youth website; DSW Fast Facts [PDF] on May 6 2008; and email from Tirsit Grishaw to The Communication Initiative on November 6 2009.