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A call to end the silence on fistula

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Ms Jolly Twongyeirwe, Communication Officer 

Amidst the lush landscapes and vibrant cultures of Uganda, a silent epidemic continues to afflict thousands of women silently and relentlessly, obstetric fistula.

This debilitating childbirth injury, often resulting from prolonged and obstructed labour, leaves women in excruciating pain and facing profound social stigma. Yet, despite its devastating impact, obstetric fistula remains largely overlooked.

Obstetric fistula, a condition characterised by an abnormal opening between the vagina and the bladder or rectum, is entirely preventable and, in most cases, treatable.

However, the reality for many women in Uganda is far from promising. Limited access to quality maternal healthcare services, especially in rural and remote areas, exacerbates the risk of obstetric complications. Insufficient infrastructure, inadequate training of healthcare providers, and cultural barriers further compound the challenges.

According to WHO, each year, Obstetric Fistula affects approximately 50,000 – 100,000 women worldwide. In Uganda, it is estimated that more than 190,000 women and girls are living with fistula.

The statistics paint a grim picture, with an estimated one  in 50 women in Uganda will experience obstetric fistula in their lifetime. Yet, behind these numbers are untold stories of pain, isolation, and resilience.  It is against this background that the Ministry of Health has decided to step up its efforts to prevent new cases, provide treatment and support for affected women, and challenge the stigma surrounding the condition.

At the forefront of this fight is a comprehensive National Obstetric Fistula Strategy that addresses the root causes of the condition while ensuring that women receive care and support, and provides skilled attendance at births to accelerate the reduction of maternal and neonatal mortality and morbidity, as well as functionalising all health Centre IVs to offer comprehensive emergency obstetric care.  By expanding access to these essential services, the ministry aims to prevent obstetric complications.

The impact of obstetric fistula extends far beyond the physical realm, it permeates every aspect of a woman’s life. Stripped of their ability to control bodily functions, women with fistula often face discrimination, shame, and psychological trauma. Many are ostracised by their communities, unable to participate in social activities or pursue education and employment opportunities. The vicious cycle of poverty and poor health perpetuates as these women become marginalised and economically disadvantaged.

In addition to prevention efforts, the Ministry of Health and its partners are committed to providing comprehensive treatment and rehabilitation services for the affected women. This includes expanding access to surgical repair services, as well as providing psychosocial support, vocational training, and economic empowerment initiatives to help women rebuild their lives after treatment.

By addressing the physical, emotional, and socioeconomic consequences of fistula, the Ministry of Health is working to restore dignity and hope to the affected women.

As Uganda gears up for the International Day to Eliminate Obstetric Fistula (IDEOF), to be commemorated on May 29 in Namayingo District under the theme “Breaking the cycle: Preventing Fistula Worldwide,” It is important to recognise that beyond policy and infrastructure, ending obstetric fistula demands a shift in societal norms, attitudes and perceptions. We must foster a culture of compassion and understanding, where these women are embraced with empathy and support, they need to rebuild their lives.

Addressing obstetric fistula also goes beyond medical interventions, it requires a concerted effort, and a multi-sectoral approach to challenge the stigma and discrimination that surrounds the condition. On its part, the Ministry of Health launched awareness campaigns aimed at educating communities about obstetric fistula, dispelling myths and misconceptions, as well as promoting acceptance and support for affected women.

By engaging with religious, and cultural leaders, and the community as a whole, the Ministry of Health is fostering a culture of compassion and solidarity that empowers women to seek help without fear of judgment.

Ms Jolly Twongyeirwe is a Communication Officer at the

Ministry of Health. @JollyAtwine on X