Overcoming fistula: A survivor’s remarkable story

NAMORROI, Mozambique – In just one year, the life of 21-year-old Carleta Eugenio Francisco has transformed completely. Before, she was isolated in her community in Namarroi District, Mozambique, stigmatized for suffering from the effects of obstetric fistula – a hole in the birth canal caused by prolonged, obstructed labour.

But today, with treatment, she has reclaimed her confidence and her life. “I want to go continue my education to become a nurse in the future, to help save the lives of young pregnant women in my community,” she told UNFPA.

The most marginalized

Obstetric fistula is almost entirely preventable, yet it continues to happen, largely among the world’s most marginalized, impoverished women and girls. The toll of this injury is devastating. Women and girls are left leaking urine or faeces, and can face other physical problems, including frequent infections. They are often shunned, unable to work or go to school, and driven deeper into poverty.

Like other women and girls who endure this condition, Ms. Francisco was no stranger to misfortune.

As a child, she used to leave home at 5 a.m. every day to make it to class – the nearest school was two hours away. But community members discouraged her from going, saying the long commute was putting her in danger. Violence against girls both in school and on the way to school is a serious impediment to girls’ education in Mozambique.

“I loved school and didn’t want to let the discrimination of neighbours come in my way,” Ms. Francisco told UNFPA.

But school brought her a fate very different from the one she expected. Her teacher proposed to her, and with the consent of both their families, the two were married. Ms. Francisco immediately became pregnant. She was only 16.

Ms. Francisco dropped out of school and soon gave birth at the nearest hospital, a two-hour drive away, to a baby girl named Rosa. Her husband abandoned her soon after.

A traumatic injury

Ms. Francisco returned to her mother’s house with baby Rosa, and became responsible for supporting the family. Several years later, she became pregnant again. But this time, she had no one to take her to the hospital.

When she went into labour, it became apparent something was wrong. But her mother, who was disabled, was unable to arrange emergency transportation.

“I couldn’t help my daughter,” her mother said. “I was desperate.”

Ms. Francisco survived, but her son was stillborn, and the ordeal left her with an obstetric fistula. The condition caused both chronic pain and incontinence. It also compromised her ability to walk.

When she did leave the house, community members ridiculed her. She was ostracized by members of the church where she sang in the choir. Traditional healers tried to cure her condition, but to no avail.

Still, Ms. Francisco refused to lose hope, and she eventually found her way to treatment.

Committed to the health of girls and young women

The Mozambique Ministry of Health has launched a national strategy to prevent and treat fistula. UNFPA is supporting these efforts, focusing on training health professionals to perform difficult fistula repair surgeries. UNFPA is also helping civil society organizations, such as community radio programmes, youth associations and local NGOs, raise awareness of sexual and reproductive health and rights issues, including obstetric fistula.

Last year, Ms. Francisco heard on the radio about a fistula treatment programme at Gurue District Hospital. She received successful surgical treatment at the hospital, and she returned home with newfound confidence.

Today, she has resumed her place on the church choir and plans to return to school to work towards her dream of becoming a nurse. “The nurses and doctors attending to me during the fistula operation inspired me,” she said.

And she has already begun to improve the health of the women in her community: She is now working as a community activist, advocating for family planning and safe motherhood through a local NGO and UNFPA partner.