France Donnay UNFPA Representative Pakistan

1. Toward Women’s Health and Rights Campaign to End Fistula France Donnay UNFPA Representative Pakistan 8 March 2007

2. Obstetric fistula Fistula is caused by prolonged, obstructed labor. The pressure of the baby’s head against the mother’s pelvis causes extensive tissue damage, leaving a hole between her vagina and bladder or rectum, making her incontinent. The baby usually dies.

3. Obstetric Fistula Here is a Bangladeshi woman with a picture of her baby boy. Her husband left her. She is waiting for the operation. How hopeful she looks…

4. Primarily affects young, poor women with little or no access to services Medical consequences: incontinence, infection, infertility Social consequences: isolation, abandonment, stigma, vulnerability Living With Fistula

5. How common is fistula? Incidence: • Global: 50,000 to 100,000 new fistula cases each year (WHO) • Kenya:1 to 2 fistula cases per 1,000 deliveries • East Africa: 3 to 5 cases per 1,000 deliveries in areas with no access to EmOC Prevalence: • 2 million worldwide (WHO) • Kenya – 30,000 • Bangladesh – 70,000 • Nigeria – between 400,000 and 800,000

6. The Campaign to End Fistula The Campaign to End Fistula aims to make fistula as rare in Africa and Asia as it is in the industrialized world. The Campaign involves a wide range of partners and supports close to 30 countries. UNFPA Strategy: Provide a continuum of care from prevention to treatment to social reintegration into families and communities

7. Before the Campaign • Limited information available on obstetric fistula • Fistula not acknowledged by government policies or health systems • Women encounter many barriers to accessing quality obstetric services to prevent fistula • Treatment services unavailable or inadequate • Almost no provision of social support services for fistula survivors

9. National Level Planning & Advocacy • Raise awareness among national stakeholders • Form intersectoral coalitions and partnerships • Build capacity through training and equipment provision • Needs assessments provide crucial data • Develop national strategies and plans of action in connection with safe motherhood

10. Strategic Interventions: Prevention • Helping couples plan & space their births • Skilled attendant at each birth • Available and accessible emergency obstetric care • Educating and engaging men and women about the need for maternal health care

11. Strategic Interventions: Treatment • Quality surgical and post-operative care • Training health professionals and strengthening hospitals • Make sure it is free of charge (most too poor to pay)

14. Strategic Interventions: Social Reintegration • Counselling • Health Education including follow-up care and the next pregnancy • Skills training, small grants

18. Global and Regional Advocacy • Extensive media coverage • Published journal articles • Presented at numerous global/regional technical fora • 4 international/regional fistula meetings • Campaign Website, brochure, logo • Celebrity spokesperson: Natalie Imbruglia • Innovative PR campaigns with private sector • Fistula as a compelling issue to mobilise a diverse funding base

19. Lessons Learned from Country Implementation • Comprehensive approach is needed, including prevention, treatment and social reintegration, in the safe motherhood context - emphasis on prevention • Needs assessments important first phase for both planning and advocacy • Treatment services should be available before public awareness activities are undertaken • Support services should include psychosocial, social and economic components • Diverse, multi-sectoral partnerships at all levels ensure a comprehensive and coordinated response

20. MDG Task Force Recommendations • SRH – including family planning - essential for both maternal and child health goals • Strengthening health systems is key, from community practices up to first level referral facilities • Professional attendance (w/h attention to overmedicalization) and EMOC when complications • Focus on equitable access by removing financial and cultural barriers • Address HR issues including brain drain, devolution, rights and working conditions of health workers • Build capacity of information systems

21. UNFPA: our response • Family planning : prevent unwanted pregnancy and unsafe abortion • Skilled care at childbirth : a skilled attendant in an enabling environment • Emergency Obstetric Care to manage complications • Essential Neonatal Care • Maternal nutrition • Access for the poor • Maternal morbidity : Obstetric Fistula

22. Campaign Progress • Bangladesh • Providing treatment • Training health personnel • Improving data collection and monitoring systems • Niger • Broad partnership established • Training for community health agents • Providing innovative support services

23. Fistula is a lens onto many issues Fistula highlights: • Reproductive rights • RH and Safe Motherhood • Adolescence and Early Marriage/Childbearing • Poverty

24. Campaign Supporters • Governments: Australia, Austria, Canada, Finland, Luxembourg, New Zealand, Switzerland • Gates Foundation • United Nations Foundation • Human Security Fund • Regional Development Banks • "34 Million Friends" Campaign • Innovative partnerships under development with the private sector

31. Fistula as Catalyst? • Accelerating contribution to MMR and RH programs • 5 ingredients : • political commitment • female education • strengthening of health systems • supportive family and community practices • roads and telecommunications • Political movement taking advantage of MDG momentum

32. Why focus on fistula? • Many women are affected • Fistula is Preventable and Treatable • Strategy for reaching the poorest women • Fistula puts a face to reproductive health issues