08 January 2014
More health care workers in sub-Saharan Africa and South Asia will be able to prevent, detect and treat the disabling condition obstetric fistula thanks to a new project sponsored by the U.S. Agency for International Development (USAID).
USAID announced on January 6 that it had awarded the Fistula Care Plus Project, a five-year cooperative agreement with a ceiling of $74.49 million, to EngenderHealth and its institutional partner, the Population Council. The Fistula Care Plus Project aims to strengthen health system capacity for fistula prevention, detection and treatment in sub-Saharan Africa and South Asia, as well as reintegration of women and girls who have suffered from the condition.
Obstetric fistula, a hole that develops between the birth canal and one or more of a woman’s internal organs, is caused by obstructed labor without access to timely and skilled medical care, such as cesarean section. Delaying the age of first pregnancy and increasing access to contraception are also critical to the prevention of fistula, according to USAID.
Fistula results in chronic, uncontrollable leakage of urine and/or feces, a devastating disability that affects a significant number of girls and women in Africa and Asia. New cases — all preventable — are continuing to occur, USAID said, and often women who have fistula from obstructed labor also bear the sorrow of the loss of the baby.
“Women with fistula live a devastated and painful existence that not only impacts their marriages and makes them social outcasts, but threatens their health and the health of their children,” said Dr. Ariel Pablos-Méndez, assistant administrator for the Bureau for Global Health at USAID. “Together with our partners, USAID will continue to transform the lives of women living with fistula and work to address the underlying causes.”
Fistula Care Plus activities will begin immediately in Bangladesh, Democratic Republic of Congo, Sierra Leone, Niger, Nigeria and Uganda. The project will strengthen environments to enable fistula prevention and treatment; increase community awareness and support for women and girls with fistula; reduce barriers to accessing prevention, detection and care; and improve the evidence base for approaches to improve fistula care. The activities will focus on new partnerships, innovations and sustainable approaches.
Since 2004, USAID has supported programs to prevent and treat fistula, including clinical services, work with communities to find cases and reduce stigma and research to improve understanding of risk factors and treatment approaches. In that time, USAID has supported programs in 15 countries at 57 health facilities across Africa and Asia.
USAID has funded more than 33,000 fistula repair surgeries and trained thousands of individuals — including surgeons, nurses and health care and community outreach workers — on fistula repair surgery and care, thereby creating a sustained network of individual and fistula repair centers that can provide treatment for the enormous backlog of women living with fistula and awaiting surgery. USAID also promotes a robust program of fistula prevention through family planning, early identification of prolonged labor and prompt treatment with cesarean section, and safe surgical practices to prevent fistula caused by surgical injury, the agency said.
Other partners that will be working with EngenderHealth include Dimagi, TERREWODE, Direct Relief, the Fistula Foundation and the Maternal Health Task Force, all of which will be coordinating to make fistula as rare in Africa and Asia as it now is in the Americas and Europe.
“Fistula Care Plus is one more step to ensuring that no mother or child suffers from something we could have prevented and the prevention strategies for women in labor are an essential component of improving pregnancy outcome and newborn survival. USAID’s work on fistula prevention is part of USAID’s goal of ending preventable child and maternal deaths,” the agency said.