…Stigma still deterrent, evasive against women with fistula: Amnesty International Zimbabwe

Ngoni Dapira

“It’s been three years now, I can’t wear underwear, urine is always leaking. I have developed sores on my genitals that aren’t healing because of the moisture. I dread going out in public. The last time I went to a gathering, people distanced themselves from me because of the bad smell, it repelled them. I’m confined to this house so I can bathe each time I soil myself. My entire family believes I was cursed, they say no one has ever had a disease like mine before.”

THAT is an excerpt from a 2021 report by Amnesty International Zimbabwe (Index Number: AFR 46/4112/2021) titled “Barriers to treatment and human rights abuses against women and girls with obstetric fistula in Zimbabwe,” in which  Nyaradzai (Full name withheld), a 19-year-old woman from Mashonaland West province, amongst many other women narrated their ordeal.

Whilst most people barely know about Obstetric Fistula (OF), it is fast becoming a women mortality ailment which sadly in Zimbabwe several women have faced and are still facing a lot of stigma due to traditional beliefs and misconceptions associated with the condition.

Obstetric fistula is a distressing childbirth injury that leaves women with a condition where they lack control over urination or defecation, or both. This condition is referred to as incontinence medically.

Last week Monday, Zimbabwe joined the rest of the world to commemorate International Day to End Obstetric Fistula. It is commemorated on 23rd of May each year. In a press statement, the United Nations Population Fund (UNFPA) Zimbabwe called for greater support for the ‘Campaign to End Fistula’ in Zimbabwe to help restore the dignity of women and girls who have the condition.

UNFPA Zimbabwe, has been working with the Ministry of Health and Child Care (MOHCC) and other partners on the ‘Campaign to End Obstetric Fistula’ in Zimbabwe since 2015. This has been through the support of the Health Development Fund with financial support from the Governments of Britain, Ireland, Sweden and the European Union.

Support provided included setting up a center of excellence for fistula repair surgery at Chinhoyi Provincial Hospital where a number of repair camps are conducted for free. To support the campaign over 58 health personnel including nurses and doctors, were trained in the pre and post- operative management of Obstetric Fistula through a mentorship programme conducted by the Women and Health Alliance (WAHA) and the Ministry of Health and Child Care. This was through camps that were conducted every quarter in different parts of the country, supported by technical expertise from the region. A recent 2021 study states that repair success rates are 96 percent in Zimbabwe, whilst the program also covers transport, food and accommodation costs for patients.

UNFPA country representative Dr Esther Muia said since the programme began in 2015 they have restored the dignity of over 700 women who are now living normal lives.

“As the world commemorates the International Day to End Obstetric Fistula, UNFPA remains committed to continuing support to the Ministry of Health and Child Care to ensure the accessibility to fistula repair services for women whose lives have been negatively affected by fistula, ” she said.

Dr. Muia said while corrective surgery is important, the key to addressing the problem of obstetric fistula is preventing its occurrence. “We must ensure that every woman delivers with skilled assistance, in a health facility, where they can access appropriate basic obstetric care and emergency obstetric care in the event that complications arise during delivery,” she said.

Adding, “Additionally, availability and access to voluntary family planning information and services to those who want, would reduce the number of women dying or being injured during child birth by at least 20 percent.”

The World Health Organisation (WHO) says that obstetric fistula is preventable by reducing the number of early and unplanned pregnancies, ending harmful practices such as child marriages and ensuring access to quality emergency obstetric care, especially access to caesarean sections. WHO further states that when access to quality treatment is available, obstetric fistula is curable, citing that with expert care, surgical success rates of treating obstetric fistula are as high as 90 percent.

However, the new Marriages Act that became law last Friday is expected to end the problem of child marriages as it banned the practice with those solemnising such marriages facing at least five years in jail. This is a long awaited development that nonetheless requires political will to really become effective given the political influence of apostolic sects such as Johanne Marange, known to religiously practice child marriages.

UNFPA also said that as the lead Sexual and Reproductive Health and Rights (SRHR) technical partner to the Government of Zimbabwe, it remains committed to support safe motherhood initiatives that promote access to and use of quality maternal health services for all women.

“Services provided by skilled health personnel before, during and after childbirth include emergency care for life-threatening obstetric complications, family planning to enable women to plan their pregnancies and prevent complications related to too many, too close, too early and too late pregnancies. It also includes information sharing as well as appropriate age for sexual and reproductive information and health services for adolescents and young people,” read the statement.

Dr Muia however added that communities have a big role to play in preventing obstetric fistula by discouraging child marriages as young girls often get fistula injuries during childbirth because their bodies would not have matured for child birth. However, with the recent high cases of teenage pregnancy in the country the problem of obstetric fistula threatens to continue to be a cause of concern.  She cited that nutrition for proper bone development is also key.

On the other hand, whilst milestones have been made since 2015, according to a 2021 report by Amnesty International Zimbabwe, it states that although repair of obstetric fistula was established as a public health intervention in 2015, a study has shown that access to maternal healthcare which could prevent obstetric fistula as well as treatment for obstetric fistula has remained limited for many women and girls in Zimbabwe.

The report analysed the barriers to access that women in Zimbabwe face in relation to obstetric fistula prevention and treatment and concludes that the Government has failed to uphold sexual and reproductive health rights and the rights to equality and privacy and to be free from torture and other ill-treatment of women and girls.

The report included testimonials of how many women like Nyaradzai and young girls with fistula are often not accepted in society because of their odour and wind up having to endure depression and poverty because they cannot work in public with their condition. Many end up abandoned by their husbands and families, further driving them into poverty and suicidal tendencies. Their isolation means they often go unnoticed by family and the community and as a result, little action in the past was taken to address their condition.

                                                         One of the testimonials by a young girl that eventually got treated of OF, but suffered a lot from stigma.

Amnesty International Zimbabwe as recommendations in the report suggested that raising more awareness about the causes and treatment of obstetric fistula can assist in dispelling myths and superstition that women with obstetric fistula have been bewitched. Stigma at community level because of superstitious beliefs and lack of know-how about the condition remains a deterrent for women to come out and seek medical help. The report also cited that despite the success of the Ministry of Health and Child Care fistula programme in providing free surgical repair for obstetric fistula, promotion of the program has yet to reach all health facilities, throughout the country, which is a gap that must be addressed, especially in rural communities.

Covid-19 was also cited as a major contributor of the increase in fistula conditions present-day. “The advent of the Covid-19 pandemic has adversely affected programming for obstetric fistula in Zimbabwe. A study published in April 2021 by Chimamise et al. noted that because of restrictions imposed due to the pandemic, only 25 women had repair surgery in 2020, compared to 313 in 2019,” read the Amnesty International Zimbabwe 2021 report.

Globally, obstetric fistula affects between 50 000 and 100 000 women every year, with low income countries in Africa and Asia bearing the highest burden. In Zimbabwe, the actual rate of obstetric fistula is not known, but given that the latest Multiple Indicator Cluster Survey from 2019 indicates that the country’s maternal mortality ratio is among the highest in the world, so it can be expected there is a devastating prevalence and incidence rate of obstetric fistula in the country.

Amidst an ever-worsening economic situation in the country, as well as the country’s consistently low healthcare budget allocation, Amnesty International says that the Government has failed to assign sufficient resources to the health sector. This is regardless of having declared a policy of free maternal services. The report called on the Government to investigate the case studies in the report to comprehensively cover gaps on combating obstetric fistula.

”The lack of ambulances and high fuel prices, further compounds delays that women and girls experience reaching and receiving care at health facilities. The situation is urgent as the country weathers the impact of the Covid-19 crisis and barriers to maternal health services are increasing.”

Further stating that, “Amnesty International also found that a preference for home births was influenced by traditional practices and or the costs associated with giving birth in health facilities, limiting women’s access to quality post-partum care. This report documents serious abuse that may amount to torture and ill-treatment of women and girls committed by private individuals, during labour at home. The government of Zimbabwe has an obligation to investigate these cases,” read part of the report.

For any information and assistance, including further information on surgery, related to fistula please call on the toll free number 08080231.