Experts in Africa Meet to Develop Training Guidelines for Fistula Treatment

NIAMEY, Niger —Improved training for medical workers providing fistula treatment would help end the needless suffering of thousands of African women with obstetric fistula, experts meeting in Niger agreed on Friday.

Assembled from across the African continent, Niger government officials, members of international agencies, medical professionals, non-governmental organizations (NGOs) and representatives from UNFPA, the United Nations Population Fund, gathered to map out a set of training standards for fistula surgeons, nurses and counsellors in a two-day meeting.

"Prevention is the key to ending obstetric fistula. However, when fistula injuries do occur, women must have access to appropriate medical treatment," said Dr. France Donnay, Chief of the Reproductive Health Branch at UNFPA. "We must ensure that doctors and other health care providers treating fistula patients have the quality training they need to help relieve these women from their suffering."

Obstetric fistula is a devastating childbearing injury that occurs when a woman endures obstructed labour – often for several days – without the necessary emergency medical intervention, typically a Caesarean section. In nearly all cases, her baby dies, and she is left with chronic incontinence.

Women suffering from fistula are often abandoned by their husbands or ostracized from their communities. Reconstructive surgery can repair their injuries in most cases. Unfortunately, many women with fistula are either unaware that treatment is available, or they cannot afford it.

It is critical that providers receive quality training to treat the backlog of fistula patients, experts attending the Niamey meeting agreed. Hospital staff should be trained as a team to manage fistula cases. Simple cases should be handled at district hospitals, while more complicated cases should be referred to specialized regional hospitals. Furthermore, medical students should be encouraged to assist in fistula repair centres to gain the required surgical expertise, said delegates.

But doctors cannot solve the problem alone. Governments need to develop national strategies to combat fistula, and health centres handling fistula cases must have the necessary equipment and funding to provide essential care, experts agreed.

"We are committed to ending the suffering of women living with fistula," said Marlene Francois Lays, UNFPA Representative in Niger, who opened the meeting. "Together, we, the Representatives of African Governments, health professionals and UNFPA, will work together to help deliver treatment to the women who need it and prevent future cases from occurring."

Once their physical injuries are repaired, patients need appropriate counselling so that they can reintegrate into society and prevent future injuries from occurring. Delegates discussed counselling needs and guidelines to ensure that all repaired women seek skilled care during their next pregnancy and receive information on fistula prevention and family planning. Counselling is also needed at the grass-roots level for the women and their communities. Religious leaders and elected officials can be instrumental in getting the necessary messages out to the community, experts agreed.

The World Health Organization estimates that more than two million women are living with fistula in developing countries with an additional 50,000 to 100,000 new cases occurring each year. These figures are based on the number of women seeking treatment, and are likely to be gross underestimates. In areas with high maternal mortality, fistula may occur at a rate of two to three cases per 1,000 pregnancies.

The Niamey meeting is part of the "Campaign to End Fistula" led by UNFPA and its partners. The global effort was launched in 2003 and now is under way in more than 30 countries in sub-Saharan Africa, South Asia and the Arab region.

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UNFPA is the world’s largest multilateral source of population assistance. Making motherhood safer for all women is at the heart of the Fund’s mandate.

Contact Information:

New York: Micol Zarb, zarb@unfpa.org, tel. +1 212-297-5042

Senegal: Angela Walker, awalker@unfpa.org, tel. +221-889-0356