14 year old Fanny will not give you details about what happened to her after she fell pregnant. Neither is she going to talk about the complications she developed whilst giving birth.
But there is one complication she has failed to conceal from everyone else; this is because it has kept her away from all kinds of gatherings such as funerals and weddings.
Even though it is common knowledge that Obstetric Fistula is mostly caused by complications of child birth, Fanny insists she just developed it, even in the presence of health workers that fully know her medical history well.
United Nations Population Fund–UNFPA describes Obstetric fistula as one of the most serious and tragic child birth injuries. It is a hole between the birth canal and bladder or rectum caused by prolonged, obstructed labour, without access to timely, high-quality medical treatment. Fistula leaves women leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty.
Fanny’s lack of confidence to share what she went through is enough evidence of the internal self-stigma that Fistula brings to every woman who has it, whether young or old.
Obstetric fistula is one of the most challenging injuries to live with. It is often associated with stigma, discrimination and loss of social contact and association. In most instances, stigma forces women living with the condition to remain hidden and isolated by their families, friends and communities. Most of them would have been abandoned by their husbands; most are young and uneducated, with minimal economic means to fend for themselves.
The only thing Fanny freely tells is: “This condition has brought me a lot of misery and suffering. Nobody wanted to be close to me. I have faced high levels of discrimination. I was so lonely. My relations are now used to my condition but they initially couldn’t.”
Issues of early marriage and teen pregnancies have become older of the day and they leave the impression that they only end with the girl child having a baby – but it goes further to Fistula too.
Malawi Demographic and Health Survey (MDHS) of 2016 shows that teen age (15-19) pregnancies have increased in Malawi, from 26 percent in 2010 to 29 percent now.
It further indicates that 31 percent of women of the same age bracket in rural areas (like Fanny) have begun child bearing as compared to 21 per cent of their urban counterparts.
UNFPA notes that Malawi is one of the Sub Saharan countries whose youths still have problems to access sexual reproductive health services information and services, hence the unwanted teen pregnancies.
According to information sourced from Mulanje District Hospital, Mulanje has a contraceptive prevalence rate of 36 per cent across the board.
According to Fistula Coordinator at Mulanje District Hospital Georgia Namakhu, every woman is at risk especially adolescents because their reproductive organs are not developed enough to handle child birth.
She revealed that the situation has been worsened because women take long before going to a health facility.
“The women usually present cases of long labour. We established that they delay at Traditional Birth Attendants.”
“The 14 year old fell pregnant when she was very young. Since she is very young, she might have missed the important points during antenatal visits. The fact that she has no support from a partner like husband to help her remember what she was told at the visits is also another contributing factor,” Namakhu said.
She is quick to encourage women in other areas to go to any public health facility to have their fistula repaired.
But Fanny, a standard six pupil, insisted that she would go back to school once her fistula is repaired.
Senior Community Development Assistant at Mulanje District Hospital, Jessie Mlenga said from what she has learnt in the course of her duties in the communities, most women in rural areas do not know about Fistula.
She explained that most young women (like Fanny) are having the problem due to early sex debut, fuelled by harmful cultural practices. They develop pregnancy related complications, including fistula, in the course of delivering the baby.
“We have observed that some cultures are contributing to early sex debut. At times, women are developing this problem because they have delivered many children which strain the reproductive organs.”
“We want people to understand the consequences of harmful cultural practices. We are also doing civic education targeting particularly men: Those whose wives have fistula and those whose wives have never had it. We try to make them understand that the women develop the problems after a sexual activity which they both were involved in. It’s very traumatising for the women who have this problem,” Mlenga pointed out.
She added that most people believe that women develop Fistula because they have been bewitched, saying some women have even grown old and died whilst having this problem.
Mlenga acknowledged that the women face a lot of challenges because of Fistula, citing divorce as one of the first things that happen to a woman who has just developed fistula.
“The husbands can’t stand the smell. Such women don’t socialise at all because of the urine and stools they leak. They are always discriminated, even by family members. We are helping people to understand that every woman in child bearing age could have this problem,” she elaborated.
Fanny happens to be one of the 40 women that had their Fistula repaired during the Fistula camp held between April 20 and May 2, 2018 which UNFPA conducted at Mulanje District Hospital.
According to Clinical Officer at the facility, Regan Dulani, Fistula is a big problem in the district and that projected statistics on its prevalence may not be a true reflection of what is on the ground because many women are ‘hiding’.
He explained that after the repair procedure, a woman is supposed to stay a minimum of 10 days in hospital.
“This problem has always been there. Just that people have misconceptions. Women have been advising each other that there are other medicines, including native ones but it is not true. The majority of women that come here later on have native medicine marks on their bodies,” Dulani said.
He corroborated reports of discrimination, especially by spouses who mostly psychologically torture the women or abandon them.
“The women with Fistula are human beings just like everybody else. They also have feelings…. they could also have sex. Just that at times, men are selfish and they don’t want anything to do with such women,” Dulani explained.
SRHR Coordinator for UNFPA Grace Hiwa, said since 2003, UNFPA has been on a campaign to end fistula.
She added that in Malawi, women of child bearing age (15-49) develop fistula, “Most women live in rural areas and they don’t know much about this condition. Such women are not happy. UNFPA wants to help these women who have Fistula in any country so that they should have their dignity and health back.”
She further observed that not many health workers are trained to do fistula repairs.
UNFPA, Freedom from Fistula Foundation and International Medical Response (IMR) have been supporting fistula repairs through fistula camps. The cost for organising such camps is estimated at MK30, 500,000 (estimated $42,000)
This is the sixth time the district is conducting a repair camp at Mulanje District Hospital since 2015. During the first Obstetric fistula repair camp in Mulanje, over 25 women were repaired. Among those repaired was a woman who had lived with fistula for 66 years. From the time UNFPA started to support Mulanje DHO in repairing Obstetric Fistula cases, a total of 120 women have been repaired.
The Mulanje Obstetric Fustula camp targeted women from Mulanje and Phalombe and all the Southern Region districts.
Apart from Mulanje District Hospital, the UNFPA supports obstetric fistula camps at Bwaila Hospital, Dedza, Nkhatabay, Chikwawa, Mchinji and Mangochi districts every year.
According to UNFPA, Obstetric Fistula is a problem in Malawi as one in every 100 women of reproductive age has the condition. Four out of ten women (like Fanny) in the rural setting know about obstetric fistula against six out of ten in the urban setting.
UNFPA has over the years supported the Government to reach out to women living with this complication. The Malawi Government, with support from UNFPA, started strengthening the Obstetric Fistula program in Malawi (in 2003) following the launch of the global campaign to end. UNFPA invests over $150, 000 per year into Obstetric Fistula repairs.
Proposed support interventions to end obstetric fistula:
- Supporting girls to stay in school and attain higher level of education such as secondary school and college
- Promoting gender equality
- Support and encourage youth to use availability of services like youth friendly services that empower youth in making right reproductive choices
- Eliminating or modifying cultural practices that perpetuate injustices and inequality between boys and girls, men and women
- Be proactive in ending early marriages in our communities that lead to early pregnancy exposing young girls to obstetric fistula
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