Obstetric Fistula: An unheeded public health and human rights issue

The significant role of women in the socio-economic, political, and cultural settings globally cannot be overlooked, as they are a major backbone to the sustainability of strong families, values, and human development.

Society considers their roles as good mothers and wives non-negotiable even at the peril of their lives, and these places on them the herculean task of ensuring the proper upbringing of the next generation while combining all these with other domestic chores.

Most women often support their husbands with earnings from their jobs and ensure that the family’s health and nutritional statuses remain good and socially acceptable.

Regardless of these contributions and sacrifices, women receive the least credit for their worth and continue to suffer neglect and needless deaths from debilitating health complications like Obstetric Fistula (OBF).

OBF is a serious medical injury where an abnormal opening forms between the woman’s genital tract and bladder, and or rectum, resulting mostly from a prolonged and obstructed childbirth, in the absence of emergency obstetric care.

This results in the constant leaking of urine, faeces, or both, and if not treated early, could cause chronic health problems like skin infection, kidney diseases, infertility, nerve damage, and even death.

Several underpinning factors can be associated with the occurrence of OBF in women, and these include negative cultural practices such as the early marriage of girls, malnutrition, female genital mutilation, poor health-seeking behaviours of people, timely access to healthcare and emergency services, poverty, and stigmatisation.

STIGMATISATION AND ITS EFFECTS

Obstetric Fistula is a devastating health problem due to the stigma associated with the constant incontinence of urine, faeces or both, and the accompanying stench.

The stigmatisation of persons affected by fistula can be through verbal abuse, ostracism, or the woman’s anticipated fear and shame that people may talk about her, leading to low self-esteem.

“My sister’s childhood friends in our village used to gossip behind her back, and even cover their noses when she tries to socialise with them, accusing her of coming to infect them with her witchcraft and curse by the gods,” Amina (not her real name) who is a caregiver to a fistula patient, told the Ghana News Agency in Accra.

Due to stigma, most affected women often isolate themselves from social events including their usual household roles and even try to keep their condition a secret to the extent of refusing to seek healthcare.

The majority of affected women also experience mental health problems such as depression, due to the anguish, humiliation, loneliness, marginalisation and divorce they must bear.

Salamatu (not her real name) a 22-year-old fistula survivor narrating her ordeal said, “I was so angry with everyone that I planned to drink the pesticide my father bought for the farm, to end it all in one night”.

The World Health Organisation (WHO Feb. 2018) estimates that each year, between 50,000 to 100,000 women worldwide suffer from OBF, with more than two million young females living with untreated fistulas in Asia and sub-Saharan Africa, a condition that has long been eliminated by developed countries like Great Britain through surgery.

A “Report on the Burden of Obstetric Fistula in Ghana” published in 2015, by the Ghana Health Service (GHS) and the United Nation’s Population Fund (UNFPA), also reveals that the country records approximately 1,300 new cases annually, with the Northern, Upper East, and Upper West regions, recording the highest cases. Most of the afflicted from these regions are young females living in poverty and in cultures where a woman’s status in society and self-esteem are dependent on marriage and her ability to bear children.

HUMAN RIGHTS VIOLATIONS

Statistics indicate that fistula is not just a public health problem, but it is a human rights issue as well, due to the violations against sufferers, which contravenes provisions made under Article 36 of the 1992 Constitution of Ghana, which grants everyone the right to good health and a life of dignity.

The discrimination against sufferers also constitutes a violation of the Universal Declaration of Human Rights (1948), which is an international document adopted by the United Nations General Assembly under its resolution (217 A), that enshrines the rights and freedoms of all human beings, including their economic, social and cultural rights.

ACCESS TO QUALITY HEALTHCARE AND COVID-19 JABS

Dr Patrick Kuma-Aboagye, the Director-General, of the Ghana Health Service (GHS), says the perpetuation of stigma and discrimination against persons with disabilities as well as execution of negative cultural practices, are unlawful hence culprits must face severe punishment to discourage others.

He said the GHS in partnership with its development partners, are leveraging existing strategies using Community Health Nurses, health officials, and volunteers, to provide home-based health services and COVID-19 jabs to all vulnerable persons, including fistula patients and survivors within communities, with the full cooperation of their family members.

“This is to achieve Ghana’s COVID-19 mass vaccination target of 20 million Ghanaians by 2022, and if for any reason, some persons are being missed out, then they must have missed the community awareness and education, and I will encourage their families to help them to exercise their health rights,” he said.

Dr Chris Fofie, the Director of the Safe Motherhood Programme of the GHS, explains that major OBF surgical repairs in Ghana, are done at the Mercy Women’s Catholic Hospital at Mankessim in the Central Region, and the Tamale Fistula Centre at the Tamale Central Hospital, in the Northern region.

According to him, although other facilities like the Greater Accra Regional Hospital at Ridge, and the Korle-Bu Teaching Hospital, can manage less complex cases the limited number of specialists surgeons and the diversion of services for COVID-19 care, have created a backlog of fistula patients awaiting surgeries.

The government, he said, is working to improve Primary Health Care services under the Community Health Planning and Services Policy, to accelerate the attainment of the Universal Health Coverage target by 2030.