Debra A. Jones
Publication Date
January 1, 2007

Family Care International (FCI)

This 40-page advocacy booklet, produced by the United Nations Population Fund (UNFPA) and Family Care International (FCI), explores knowledge, attitudes, and perspectives on pregnancy, delivery, and fistula from 31 country-level needs assessments conducted in 29 countries in Africa, Asia, and the Arab States from 2003 to 2006. It also includes detailed findings from 6 countries - Bangladesh, Burkina Faso, Cameroon, Democratic Republic of Congo, Eritrea, and Sudan. In addition, the publication offers recommendations for policymakers, programmers, and researchers to strengthen fistula prevention and treatment programmes based on the findings.

Across country assessments, the report found that the typical fistula patient was young, developed the fistula during her first pregnancy, and lived in a rural area. Additionally, obstetric fistula was observed among women who had delivered 4 or more children. As observed in the report, many adolescent girls and women living with fistula did not utilise health services because of their limited decision-making power and attitudes and misperceptions about pregnancy and childbirth. Furthermore, political insecurity and economic instability impeded transportation and access to maternal health care services. Finally, in most regions where women lived with fistula, treatment services were minimal to nonexistent.

The report includes key recommendations for improving maternal health care and the prevention and treatment of fistula. These recommendations include the following:

Raise awareness of sexual and reproductive health and reproductive rights to address fistula: According to the report, educational and rights-based messages need to promote affordable and accessible skilled maternity care. They should demystify the root causes of fistula, describe the signs of obstructed labour, underscore the consequences of waiting too long to seek medical treatment, and reduce stigma around fistula. The report also says that messages on treatment options and social reintegration are vital for women who might be living in shame or hiding from the community. The report suggests conveying messages to all sectors of the community through a variety of means including radio, theatre, television, magazines, newspapers, and the internet.

Promote the empowerment and reintegration of women into their communities post-surgery: The report suggests reintegration programmes using a variety of strategies to give women knowledge and skills. This could include training in literacy and income-generating skills, reproductive health education, and counselling.

Involve women who have lived with fistula as equal participants in maternal health programme planning, implementation, and evaluation: The report recommends involving women in health programmes because they can help identify messaging that will resonate with communities and solutions for overcoming barriers to reproductive health care. Their voices and stories are also important for sensitising the community and highlighting the consequences of not providing adequate and affordable health care.

Promote partnerships to share key lessons and to catalyse collective action: The report suggests increasing partnerships at all levels, whether local, regional or international. The author states that building local and South-to-South partnerships is an essential strategy as the majority of expertise resides in developing countries, where fistula is most common.


Campaign to End Fistula website on September 1 2008.