Obstetric Fistula (OF) is simply the failed management of labour of pregnant women during delivery. It is an injury affecting childbearing women that has been relatively neglected, despite the devastating impact it has on the lives of girls and women. It is a severe medical condition in causing hole in either urinary bladder or vagina and or in rectum and vagina causing physical, mental and social problems in the women, usually after severe or failed childbirth, when adequate medical care is not available. The consequences of fistula are life shattering: the baby usually dies, and the woman is left with chronic incontinence. Because of her inability to control her flow of urine or faeces, she is often abandoned or neglected by her husband and family and ostracized by her community. Access to obstetric emergency care is one of the major challenges in preventing the development of OF. The availability, affordability, accessibility, acceptable and quality health services is still very limited in the most part of the country. Lack of equipped facilities and trained staff, economic constraints, religious beliefs and practices, cultural norms, Violence against Women (VAW) and previous birth experiences are the major challenges and the main cause of OF. Prevention comes in the form of access to quality health care, obstetrical care, and support from trained health care professionals throughout the pregnancy, access to family planning, promotion of the practice of spacing between births, support to women in education, and avoidance of early marriage and early pregnancy. OF prevention also involves many strategies to educate local communities on the cultural, social, and physiological factors enhancing the risk of fistula. Thus, WOREC has initiated the holistic approach to end fistula–prevention, complete management and social rehabilitation of OF survivors.
The program aims to the elimination of fistula in Nepal by focusing on major five key areas: prevention, complete management (case identification, case notification, treatment/surgery, pre-post operative care and psycho-social counselling), capacity building, social rehabilitation/reintegration and research. Similarly, the program aims at raising awareness and facilitating the process on fistula through IEC materials from community level to the level of the service providers.
The programs were implemented in coordination and cooperation with different Ministries and with the involvement of local government officers in the districts. The respective bodies were given the responsibility for the selection of the training participants to build the capacity on diagnosis, clinical management, prevention and social rehabilitation of OF cases. Hundreds of health service providers and thousands of community people were sensitizedon the issues of fistula and RH components. Regarding the quality assessment of the training, most of the participants agreed that their expectations were fulfilled through the training. Most of them felt that they would be able to use the knowledge and skills in their respective fields of work, while some participants from the SHP expressed their unwillingness to implement what they learnt in their works.
IEC materials like wall charts, pocket book and documentary were developed for the community sensitization and for the advocacy with policy makers. These materials were used for the mass sensitization and were used in the IEC fair during the 16 days activism.
The project successfully operated 73 OF cases with the success rate of average 75%. The cases were counselled and were reintegrated into the family and society. The follow-up were done to assess the status of the operated cases.
The need assessment of OF in Nepal strongly recommend for the revision of the maternal health program with special focus on OF; improving the quality and the accessibility to OF services, promoting OF care; organizing the management of prevalent cases of obstetric fistula and their socio-economic reintegration. This project came up with many suggestions and recommendations which need to be considered for future activities.