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Roselyne Sachiti Features, Health and Society Editor
WHEN Katherine Manjengwa (25) of Siamuchimbo area under Chief Nenyunga, Binga in Matabeleland North, developed obstetric fistula during the birth of her twin babies, she thought she would never have a baby again.
Five years ago, Manjengwa gave birth to twins and lost one of the babies because of prolonged labour caused by her delay to seek medical help despite having registered for prenatal care at Zhomba Clinic, also in Binga.
As a result of the prolonged labour which stretched for a week, she developed obstetric fistula, one of the most serious and tragic injuries that can occur during childbirth.
Today, Manjengwa, who underwent fistula repair surgery in 2018, is ecstatic. She now has a new baby girl, something she thought would never happen again given her torrid experience with fistula.
She is one of the hundreds of Zimbabwean women who have successfully undergone fistula repair surgery, an intervention that has restored dignity for many fistula survivors.
Many women, because of a lack of information, still suffer silently and fail to seek help.
Since 2015, the Ministry of Health and Child Care’s fistula repair programme supported by the United Nations Population Fund (UNFPA) and Women and Health Alliance (WAHA), is bringing hope to various women and their families in Zimbabwe.
While most of the surgeries are held at Chinhoyi Provincial Hospital during quarterly camps, more women will soon benefit as the Ministry of Health and Child Care and its partners are building a clinic at United Bulawayo Hospitals (UBH) to treat obstetric fistula.
Several Zimbabwean doctors have now undergone training to conduct fistula repair surgeries and hopefully, more will receive such training that will help to restore the dignity of many affected women.
UNFPA Country Representative for Zimbabwe, Dr Esther Muia, said a total of 27 local doctors have participated in the obstetric fistula repairs to date and a certification programme is currently being rolled out by the Ministry of Health and Child Care for these trained doctors to conduct fistula repair independently.
“Currently, the fistula repair is conducted through medical camp in Chinhoyi Provincial Hospital on quarterly basis in partnership with surgeons from (WAHA).
“Since 2017, UNFPA also supported mini camps for simple repairs,” said Dr Muia.
She said 560 women had fistula repair by end of 2018, since the camps started at Chinhoyi Provincial Hospital.
“Obstetric fistula is one of the most serious child birth injuries among women of child bearing age.
“Obstetric fistula is a condition in which an abnormal opening (hole) develops between either the rectum and birth canal, ureter and birth canal, bladder and birth canal due to prolonged obstructed labour.
“When labour is prolonged or obstructed (e.g by fetal/baby’s head too big for pelvis), the constant pressure of the fetal head against the mother’s pelvis restricts the flow of blood to the soft tissues of the birth canal, bladder, urethra and/rectum. This leads to death of the tissues which causes a fistula to develop,” she explained.
Dr Muia added that direct causes of obstetric fistula are prolonged obstructed labour, pelvic fracture, cancer or radiation therapy to the pelvic area which damages the tissues, sexual abuse and surgical trauma.
Indirect causes, she said, are poverty, malnutrition leading to stunted growth and inadequate pelvis development, lack of knowledge on pregnancy complications and importance of seeking maternity services early, early marriage resulting in early child birth and harmful traditional practices that damage reproductive system.
Obstetric fistula has a negative impact on women’s health and social well-being.
“It results in humiliating experiences such as continuous leakage of urine and faeces, offensive odour, infection of urinary system, sexual dysfunction. Women suffer psychosocial effects — abandonment by husbands and family members due to loss of dignity, stigma, depression and isolation within the community,” she said.
Women with obstetric fistula are indicators of the failure of health systems to deliver accessible, timely and appropriate intra-partum care.
Obstetric fistula is also an indication of delays by women to seek help immediately when in labour.
Despite its devastating impact on the lives of girls and women, obstetric fistula is still largely neglected in the developing world.
The International Conference on Population and Development (ICPD) which was convened in Cairo, Egypt, from September 5 to 13, 1994, adopted the Programme of Action, which emphasized the fundamental role of women’s interests in population matters and introduced the concepts of sexual and reproductive health and reproductive rights. A new definition of population policy was advanced, giving prominence to reproductive health and the empowerment of women.
Twenty-five years on, skilled attendance has increased from 40 percent in 1994 to 60 percent today. Yet, some women develop obstetric fistula as they stay away from health institutions, where they could get timely help.
Significant progress has also been made in reducing preventable maternal deaths in Africa. A sharp decline of 40 percent has been recorded in the maternal mortality ratio.
A woman’s chance of dying due to pregnancy or childbirth has since declined from 1-in-20 risk during her lifetime to 1-in-40 risk.
According to the State of the World Population 2019 (Unfinished Business) report, while significant progress has been made in extending access to services and information that enable the realisation of the full range of sexual and reproductive health rights, this progress has been uneven and inequalities persist. Sexual and reproductive health inequalities are deeply affected by income inequality, the quality and reach of health systems, laws and policies, social and cultural norms, and people’s exposure to sexuality education.
Addressing women’s and girls’ sexual and reproductive health rights is essential to achieving sustainable development goals SDGs.
Unlike the Millennium Development Goals (MDGs), SGDs explicitly recognise sexual reproductive health as essential to equitable development and women’s empowerment, referencing sexual and reproductive health under SDG 3, for health, and again under SDG 5, for gender equality which also references reproductive rights.
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