“I have my life back”: How one mother in Senegal is thriving after obstetric fistula

TAMBACOUNDA REGION, Senegal – “After giving birth, I developed a fistula and my life was turned upside down,” said Khady* at her home in the village of Koumpentoum, deep in Senegal’s southern Tambacounda region.

“For almost 40 years, my faeces mixed with my urine and was constantly leaking. I lost friends and was no longer invited to christenings or other ceremonies.”

Obstetric fistula is a tear to the birth canal, bladder or rectum that causes severe physical and psychological pain. It is typically caused by prolonged or obstructed labour; girls who give birth at too young an age, when their bodies are not yet ready, are especially vulnerable to this traumatic birth injury. 

Although it can be relatively easily avoided with the assistance of trained midwives (and in fact it is almost nonexistent in communities with access to basic emergency obstetric care) or repaired by obstetric surgeons, half a million women and girls around the world are estimated to be living with fistula, with tens of thousands of new cases developing every year.

In addition to the discomfort and subsequent infections the condition can lead to, women and girls with obstetric fistula are also often stigmatized and abandoned by their families, partners and communities. Unable to work, the slide into poverty, isolation and extreme vulnerability can be all-too swift.

Breaking the silence

UNFPA, the UN sexual and reproductive health agency, and local partners are raising awareness about obstetric fistula among rural communities and securing the funds needed to perform surgical repairs in even the most remote areas. Advocacy efforts and group discussions bring together women from across generations, helping them to learn and recognize the signs of obstetric fistula.

Although exact data are challenging to come by, the highest prevalence of obstetric fistula in Senegal has been reported in the Tambacounda region, where access to health care is scarce and many give birth unassisted at home or with only limited support. 

A midwife who joined the community discussion explained how the debilitating condition is linked to early marriages and pregnancies, home deliveries and inadequate access to skilled health workers. These same factors all also lead to delays in treatment.

Adama* said that a neighbour had been suffering from fistula in secret, ashamed to tell anyone or ask for help. The neighbour was stigmatized by older members of the community and rejected by her family.

“The grandmothers said she was cursed…Then her husband abandoned her. We didn't see her any more.”

But after attending an awareness-raising session, Adama said, “From the chat we had, I realized that she had a fistula.” She and her neighbours then understood what was really going on and offered their support.

Working together to eradicate obstetric fistula

Since 2018, UNFPA with the support of the Government of Canada has provided surgical care for more than 300 women in the southern Kolda and Sédhiou regions, as well as carrying out awareness-raising sessions and establishing a reception centre with three bedrooms. Each patient was consistently monitored and, once they had recovered, participated in capacity-building sessions on personal finance and livelihoods skills.

For 20 years, UNFPA has led the global Campaign to End Fistula by 2030 through advocacy, prevention, treatment and social reintegration of survivors.

Prevention strategies include family planning among vulnerable communities to avoid unintended pregnancies, child marriage and early pregnancy among adolescents. Meanwhile, advocates are encouraging antenatal consultations, childbirth assisted by qualified personnel in an equipped maternity hospital rather than at home, and emergency neonatal obstetric care, including timely caesarean sections.

Beyond being a pressing public health issue, the fact that so many women and girls are at risk of developing obstetric fistula is a barrier to their human right to live with dignity and in good health.

With dedicated social support, thousands of women like Khady are gradually recovering and reintegrating back into their communities. After six cost-free repair surgeries and with consistent follow-up care, she has even managed to set up a small business selling sweets and basic groceries from her home.

“I have my life back,” she told UNFPA.

* Names changed for privacy and protection.