Evaluation of the Campaign to End Fistula Concludes More Support and Commitment Needed

UNITED NATIONS — According to a recent evaluation of UNFPA’s contribution to the Campaign to End Fistula, strong successes in raising visibility and knowledge of obstetric fistula worldwide were achieved but more prevention measures are needed to eliminate this problem. In addition, says the report, more national and international capacity building is required to reach the goal of addressing this condition, which is caused by prolonged obstructed labour without timely medical intervention and leaves women incontinent, ashamed and often isolated from their communities.

The independent evaluation, conducted as part of UNFPA’s commitment to transparency and accountability, was led by Health Research for Action and the International Center for Reproductive Health. It reviewed programmes in eight countries covered by the Campaign, including Bangladesh, the Democratic Republic of Congo, Kenya, Niger, Nigeria, Pakistan, Sudan and Tanzania. It also reviewed the global and regional coordination, management and support to national-level efforts.

Launched by UNFPA and partners in 2003, the global Campaign to End Fistula provides prevention, treatment and psychosocial support for women living with fistula in 47 countries. More than 16,000 women have so far received fistula treatment and care, with support from UNFPA. However, this is still far from providing the necessary care to all the new cases, reason why the efforts should be rapidly scaled up.

The evaluation found that treatment has been an important focus of the national programmes supported through international cooperation, but capacity is not sufficient yet. It recommended increased assistance by the international community and strengthened political commitment at the national level to define appropriate responses, including prevention and social-reintegration measures, to end obstetric fistula.

“These results underline the need for more efforts through south-south initiatives, and more detailed guidance and tools on options to scale up effective and promising practices,” said Werner Haug, Director of UNFPA’s Technical Division. “These measures are crucial if we are to eliminate obstetric fistula as part of our global push to improve maternal health.”

An estimated two million women suffer from obstetric fistula in the developing world, with more than 50,000 new cases occurring each year. The condition is usually caused by prolonged obstructed labour, without access to health professionals and timely medical intervention —typically a Caesarean section.

If the obstruction is not relieved in time, the pressure of the baby’s head against the mother’s pelvis cuts off the blood supply to the soft tissues surrounding her bladder, rectum or vagina, leading to tissue necrosis. The baby usually dies, and the mother, if she survives, suffers from obstetric fistula.

UNFPA welcomes the results of the overall positive evaluation and is committed to the continuation of the Campaign. “We are pleased that the evaluation highlights that the advocacy and awareness raising activities have significantly contributed to greater visibility, knowledge and resource mobilization for the fistula problem, both within and outside of UNFPA,” said Safiye Cagar, Director of UNFPA’s Information and External Relations Division.

Since its launch, the Campaign raised more than $37 million, helping over 28 countries integrate fistula into relevant national policies and plans. Thanks to the Campaign and its partners, thousands of health personnel, including doctors, nurses, midwives and paramedical staff, have received training in fistula treatment and care, thereby increasing national capacity to address the issue.

However more support is needed to strengthen prevention and social reintegration of fistula survivors, foster the integration of obstetric fistula into national reproductive health programmes as well as sustainable health delivery systems, promote capacity building and retention of skilled professionals, and enhance monitoring and evaluation mechanisms to support evidence-based responses at national level. Read the full report on line.