France DonnayUNFPA Representative Pakistan

8 March 2007

Toward Women’s Health and RightsCampaign to End Fistula

Obstetric fistula

Fistula is caused by prolonged, obstructed labor. The pressure of the baby’s head against the mother’s pelvis causes extensive tissue damage, leaving a hole between her vagina and bladder or rectum, making her incontinent. The baby usually dies.

Obstetric FistulaObstetric Fistula

Here is a Bangladeshi woman with a picture of her baby boy. Her husband left her. She is waiting for the operation. How hopeful she looks…

Living With Fistula

Primarily affects young, poor women with little or no access to services

Medical consequences: incontinence, infection, infertility

Social consequences: isolation, abandonment, stigma, vulnerability

How common is fistula?

Incidence: Global: 50,000 to 100,000 new fistula cases each year (WHO) Kenya:1 to 2 fistula cases per 1,000 deliveries East Africa: 3 to 5 cases per 1,000 deliveries in areas with no

access to EmOC Prevalence: 2 million worldwide (WHO) Kenya – 30,000 Bangladesh – 70,000 Nigeria – between 400,000 and 800,000

The Campaign to End The Campaign to End FistulaFistula

The Campaign to End Fistula aims to make fistula as rare in Africa and Asia as it is in the industrialized world. The Campaign involves a wide range of partners and supports close to 30 countries.

UNFPA Strategy: Provide a continuum of care from prevention to treatment

to social reintegration into families and communities

Before the CampaignBefore the Campaign

Limited information available on obstetric fistula Fistula not acknowledged by government

policies or health systems Women encounter many barriers to accessing

quality obstetric services to prevent fistula Treatment services unavailable or inadequate Almost no provision of social support services

for fistula survivors

National Level Planning & Advocacy

Raise awareness among national stakeholdersForm intersectoral coalitions and partnershipsBuild capacity through training and equipment provision

Needs assessments provide crucial dataDevelop national strategies and plans of action in connection with safe motherhood

Strategic Interventions: Prevention

•Helping couples plan & space their births•Skilled attendant at each birth•Available and accessible emergency obstetric care •Educating and engaging men and women about the need for maternal health care

Strategic Interventions: Treatment

•Quality surgical and post-operative care•Training health professionals and strengthening hospitals•Make sure it is free of charge (most too poor to pay)

Strategic Interventions: Social Reintegration

•Counselling•Health Education including follow-up care and the next pregnancy•Skills training, small grants

Global and Regional Advocacy

Extensive media coverage Published journal articles Presented at numerous global/regional technical

fora 4 international/regional fistula meetings Campaign Website, brochure, logo Celebrity spokesperson: Natalie Imbruglia Innovative PR campaigns with private sector Fistula as a compelling issue to mobilise a diverse

funding base

Lessons Learned from Country Implementation

Comprehensive approach is needed, including prevention, treatment and social reintegration, in the safe motherhood context - emphasis on prevention

Needs assessments important first phase for both planning and advocacy

Treatment services should be available before public awareness activities are undertaken

Support services should include psychosocial, social and economic components

Diverse, multi-sectoral partnerships at all levels ensure a comprehensive and coordinated response

MDG Task Force Recommendations

SRH – including family planning - essential for both maternal and child health goals

Strengthening health systems is key, from community practices up to first level referral facilities

Professional attendance (w/h attention to overmedicalization) and EMOC when complications

Focus on equitable access by removing financial and cultural barriers

Address HR issues including brain drain, devolution, rights and working conditions of health workers

Build capacity of information systems

UNFPA: our response

Family planning : prevent unwanted pregnancy and unsafe abortion

Skilled care at childbirth : a skilled attendant in an enabling environment

Emergency Obstetric Care to manage complications

Essential Neonatal Care Maternal nutrition Access for the poor Maternal morbidity : Obstetric Fistula

Campaign ProgressCampaign Progress Bangladesh

Providing treatmentTraining health personnelImproving data collection

and monitoring systems Niger

Broad partnership established

Training for community health agents

Providing innovative support services

Fistula is a lens onto Fistula is a lens onto many issuesmany issues

Fistula highlights:Reproductive rightsRH and Safe

MotherhoodAdolescence and Early

Marriage/ChildbearingPoverty

Campaign Campaign SupportersSupporters Governments: Australia, Austria, Canada,

Finland, Luxembourg, New Zealand, Switzerland

Gates Foundation United Nations Foundation Human Security Fund Regional Development Banks "34 Million Friends" Campaign Innovative partnerships under development

with the private sector

Fistula as Catalyst?

Accelerating contribution to MMR and RH programs 5 ingredients :

– political commitment– female education– strengthening of health systems– supportive family and community practices– roads and telecommunications

Political movement taking advantage of MDG momentum

Why focus on fistula?

Many women are affected

Fistula is Preventable and Treatable

Strategy for reaching the poorest women

Fistula puts a face to reproductive health issues