May 2010

Data gapSurveys include obstetric fistula

Haiti One of the pioneers

Obstetric fistula, a severe condition caused by prolonged obstructed labour

unrelieved by timely medical intervention, remains as one of the most severe

unsolved reproductive health issues affecting developing countries. Estimates

point to at least two million women living with the condition worldwide, with

50,000 to 100,000 new cases occurring each year.

Difficulties in obtaining accurate and comparable data on obstetric

fistula prevalence continue to hinder efforts to address maternal deaths

and disabilities more efficiently. In some countries, obstetric fistula might

be considered a low-priority issue in part because its prevalence is

perceived to be low or non-existent. However, the true prevalence of

fistula is likely to be quite high.

Needs assessments conducted in early phases of the Campaign to End

Fistula were a first effort to gather national data on obstetric fistula, and they

revealed a lot about the condition. However, these were often restricted to

some centers providing obstetric-related services and captured mainly infor-

mation related to the facilities that provide treatment and not the realities

of all women, in particular those without access to care.

Without reliable knowledge about the number of women living with

fistula, it is very challenging to plan an effective response. “We know

from previous studies on maternal morbidity that women may be suffer-

ing from other conditions, such as severe stress incontinence, which is

also challenging for the woman but is not a fistula and requires a differ-

ent response,” explains Ms. Kate Ramsey, Africa Regional Programme

Coordinator, Averting Maternal Death and Disability Programme,

Columbia University.

Establishing functioning services for fistula treatment has been possible,

but getting the big picture and tracking the real numbers will help show

whether all pregnant women are receiving timely access to skilled assisted

delivery and emergency obstetric care. Where obstetric fistulas continue to

occur, it will highlight the need for further action to save women from

maternal death and disability.

The good news is that more and more countries are including ques-

tions on obstetric fistula prevalence in their Demographic and Health

Surveys (DHS). This will shed more light on the problem and pave the

way for solutions.

The Democratic Republic of the Congo, Ethiopia, Malawi, Mali, Niger,

Pakistan, Rwanda, and Uganda are examples of countries where questions

regarding fistula have been included in the DHS. Although the form varies

among countries, all these surveys contained questions regarding obstetric

fistula knowledge and symptoms.

As part of a process led by the international Obstetric Fistula Working

Group, of which UNFPA, the United Nations Population Fund, serves as the

secretariat, a standard obstetric fistula module has now been developed

for new DHS. This will allow collection of comparable data across coun-

tries, which may help improve maternal health in general and promote

political commitment to address the problem.

Filling the data gap Haiti: another pioneerPort-au-Prince, Haiti

2

After a major earthquake struck the capital city of Haiti, Port-au-

Prince, and its surroundings in January 2010, more than just debris

was left as testimony to one of the worst natural disasters in the

region. Along with helpless injured people, razed buildings and fallen

power lines, this Western Hemisphere’s poorest nation had to contend

with a collapsed health infrastructure. Nurses, midwives and doctors

were among the quake’s victims, increasing people’s vulnerability and

health related risk factors, especially among women.

Homeless women and girls in tent camps, those recovering from

quake-related injuries and pregnant women were amid the most

vulnerable. According to specialists, at the time of the earthquake

some 63,000 were estimated to be pregnant in the country, 7,000 of

whom were in the last month of pregnancy.

The news, filled with stories of women delivering their babies in

parks and tents and lacking the most basic medical care, portrayed

the inhumane conditions of a disaster zone. However, an anthropologi-

cal study on obstetric fistula recently conducted in Haiti by UNFPA

showed that even before the disaster (and certainly after it) most of

those vulnerabilities were already commonplace for the women there.

“As Haiti recovers from the earthquake, the country will have

to face not only a collapsed health infrastructure, but also a deeply

entrenched inequality and the lack of in-country trained professional

staff to deal with key maternal health problems, like obstetric fistula,”

explained UNFPA Reproductive Health Advisor, Michel Brun.

According to Mr. Brun, many of the vulnerabilities which had been

identified in an assessment of maternal health care availability before

the earthquake are certainly more acute now. “Before, we didn’t have

enough professionals, awareness about the problems or access to

health care. Now, even if we did, we wouldn’t be able to attend to

the demand because the facilities are not there anymore,” he said.

In addition, the lack of accurate information about maternal health

problems, like fistula prevalence, has always been an overwhelming

obstacle in Haiti. Although the study carried out by UNFPA Haiti a few

months ago shed some light on the problem, obstetric fistulas are,

General Hospital’s maternity ward after the earthquakes. Photo: UNFPA Haiti.

Cover photo: Elanie Jacques holds her three day old granddaughter, born to Katiana Bourdeaux, 18, in a medical tent in Port-au-Prince, Haiti, February 2010. Photo: courtesy of Lynsey Addario, VII Photo Agency.

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Spearheaded by UNFPA and supported by numerous generous

donors, the presence of the global Campaign to End Fistula has

grown tremendously since its inception in 2003 — from 12 initial

countries to now 47 countries in Sub-Saharan Africa, Asia and

the Arab region. The majority of countries is now in the full

implementation phase — a shift that illustrates the momentum

and demand gathering at country level. With the support of

the Campaign, governments and partners, increasing numbers

of women and girls are accessing the care necessary to prevent

and treat fistula — and to return to full and productive lives.

Since the launch of the Campaign in 2003:

More than 16,000 women received fistula treatment and care

with support from UNFPA;

More than 38 countries conducted situational analyses of the

issue; and

More than 28 countries integrated obstetric fistula in national

health policies or plans.

Key 2009 UNFPA Highlights:

Provided support for more than 4,400 women to receive

fistula treatment;

Supported more than 100 health facilities in 23 countries to

strengthen fistula prevention and treatment capacity;

Facilitated the training of more than 1,000 healthcare

personnel – including over 160 doctors, 245 nurses and

midwives; and more than 600 community health workers;

Facilitated the participation of fistula surgeons from Benin,

Democratic Republic of Congo, Senegal and Somalia at

the International Society of Fistula Surgeons 2nd Annual

Conference, 25-27 November 2009 in Nairobi, Kenya. The

Conference drew several participants and allowed for

knowledge exchange, professional development, and learning

in fistula prevention, treatment and reintegration (see page 6);

Eighteen Campaign countries supported fistula survivors to

sensitize communities, provide peer support and advocate

for improved maternal health at both the community and

national levels. The work of fistula survivors is expanding

both in terms of the number of countries working in this area

and the level of engagement of the survivors; and

Conducted an external, mid-term review of the UNFPA

components within the Campaign, led by a team from

Health Research for Action (HERA) & the International Center

for Reproductive Health (ICRH) that assessed national

programmatic efforts and regional/global support to

national programmes (see page 7).

according to Mr. Brun, completely

ignored as a public health issue

in the country: “That’s why

we strongly advocated for the

inclusion of a fistula module in the

Demographic and Health Survey

(DHS) wave to be conducted this

year in Haiti,” he said.

The data collected in the

2010 DHS wave, the fifth to be

conducted in Haiti, will help

researchers estimate the preva-

lence of the condition, and support

advocates’ demand to have obstetric fistula placed as a priority in national

programmes and for development assistance.

“We presented the DHS committee our preliminary study, which was a

qualitative research focused on social, psychological and economic impacts

of obstetric fistula. It confirmed the importance of including a fistula

module in this wave. It was unanimous, they all agreed,” Mr. Brun said.

The Institut Haïtien de l’Enfance and the Institut Haïtien de Statistique

et d’Informatique will be in charge of data collection, with UNFPA techni-

cal support, on questions of sexual and reproductive health in general

and fistula in particular. Mr. Brun said that UNFPA will not wait for the

results to start working on the problem.

“We know that women

living with fistula will benefit

from what we discover” he

said. “This is considered a

shameful condition here. In

terms of the social impact of

obstetric fistula, the fact that

we are looking for answers is

already a way to respond to

the problem. Now it’s still in

the private sphere, a trouble

only for the women who live

with it. They are isolated, stig-

matized, and they don’t have

any hope that they will get

a solution for their affliction.

This research and our work

in collaboration with the Government of Haiti will show that this is also a

public problem. We know that we have obstetric fistulae in this country and

we have to take it out of the shadows so that we can respond to it.”

*Since 1995, UNFPA has provided support to the Groupe Haïtien d’Etude du Syndrome de Kaposi et des Infections Opportunistes (GHESKIO) to enhance the access to quality reproductive health services for youngsters of reproductive age in metropolitan areas of Port-au-Prince, Jacmel, South and Northwest regions. Since 12 January 2010, GHESKIO began providing humanitarian assistance and emergency care to persons affected by the earthquake, who were installed in a camp near the institution.

Reproductive Health Advisor, Michel Brun. Photo: Voices.

Highlights

Read more: www.endfistula.org

Dr. Peck (right), head of community relations for GHESKIO, a UNFPA-funded health clinic in the heart of Port-au-Prince, offers counseling to a woman who lives in the new earthquake survivors’ camp that mushroomed near the institution.*

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New fistula center in 2010Dhaka, Bangladesh

Olympian brightens fistula wardDar-Es-Salaam, Tanzania

Young girl undergoes treatment in the fistula ward. Photo: UNFPA Tanzania.

Olympic medalist and UNFPA Goodwill Ambassador Yuko Arimori toured an

obstetric fistula ward in Dar-Es-Salaam, Tanzania, in February 2010, com-

mending the work on fistula treatment.

Ms. Arimori, who made history as Japan’s first Olympic medalist for

Women’s Marathon, offered her highest praise for the quality of services

provided by Comprehensive Community-Based Rehabilitation in Tanzania

(CCBRT), a recipient of UNFPA support.

Her visit underscored the endurance test that defines this nation’s efforts

to combat fistula. “Estimates point at 1,200 new cases of obstetric fistula

annually in Tanzania, or approximately two percent of cases worldwide,” said

Dr. Julitta Onabanjo, UNFPA Representative in Tanzania, which is among the

10 countries with the highest number of maternal deaths in the world.

Dr. Onabanjo noted, “Because they are often ostracized by their families

and communities, women with fistula may be isolated, often for many

years. Sadly, most women with the condition do not know that treatment is

available, or they cannot afford it.”

In 2009, Comprehensive Community-Based Rehabilitation in Tanzania

performed 160 fistula surgeries and facilitated the successful treatment of

another 30 women at hospitals in northern Tanzania.

Bangladesh’s seven year campaign of advocacy, awareness-raising, and

capacity building will culminate with a new center for fistula treatment,

slated to open in late 2010. Built with funds from the Government of

Bangladesh and support from UNFPA, the center will be based on the

premises of a public hospital in Dhaka and is expected to facilitate treat-

ment of approximately 800 obstetric fistula patients annually.

Dr. Hashina Begum, Assistant Representative in UNFPA Bangladesh, says

needs assessment data from six out of the country’s 64 districts point to at

least 71,000 obstetric fistula cases nationwide. She notes, “This center will

provide treatment and also act as a referral facility for all the districts.”

The center’s primary focus will be providing surgical procedures along

with pre- and post-surgery counseling. Staff will also work in close col-

laboration with a nearby rehabilitation facility for obstetric fistula survivors

recovering from surgery.

For Bangladesh, the center will serve as the newest benchmark in a

remarkable evolution towards maternal health. As recently as 2003, women

with obstetric fistula were condemned to suffer in silence, without a single

program or public forum to address their needs. Since then, Campaign

initiatives have enabled some 2,050 fistula patients to receive surgical

treatment in Bangladesh with an average of 300 patients treated per year.

Dr. Hashina cites progress on several key fronts, including an in-

creased capacity of professionals, greater access to quality health care,

and enhanced assistance facilitating social reintegration of obstetric fistula

survivors. “The survivors work as Community Fistula Advocates (CFAs) after

treatment,” Dr. Hashina explains.

Altogether, 35 fistula advocates are providing counseling on maternal

health to prevent obstetric fistula and promote reproductive health in

villages and communities. “Previously there was silence about fistula,” she

notes. “Women didn’t talk about it. Now the advocates interact and initiate

the discussion, encouraging obstetric fistula patients to look for help.”

Magazine brings VIPs out for fistulaThe media has long played a critical role in the efforts to raise awareness for fistula. In November 2009, ELLE Belgium took their support a step further, marking its sixth

anniversary with a VIP event honoring the Global Campaign to End Fistula. More than one thousand of Belgium’s media, fashion and arts elite turned out to celebrate and to view a special exhibition of UNFPA’s awareness campaign images, curated by RKCR/Young and Rubicam UK.

4

Fistula survivor and advocate Ms. Sultana Begum now teaches her skills to other women. Photo: UNFPA Bangladesh.

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Powerful women Freetown, Sierra Leone

Freedom from fistulaMonrovia, Liberia

A new short film produced in Liberia, “Freedom from Fistula”, is adding more

voices of fistula survivors to the fight against this devastating child-bearing

injury. Produced in 2008 by Lisa Russell of Governess Films in association with

the Ministry of Health and Social Welfare, Republic of Liberia and UNFPA, the

film offers an overview of the Campaign to End Fistula workings in the country.

“In a nation still recovering from an 11-year civil war, it was inspir-

ing to film such a progressive programme prioritizing women’s health,”

stated Emmy-award winning filmmaker Lisa Russell. “The Liberia Fistula

programme gives testament to the dedication of Liberia’s government and

health care workers dedicated to rehabilitating this beautiful country.”

Although it’s proved challenging to estimate the prevalence of obstetric

fistula in Liberia, the issue is clearly a priority. The striking scenes of Liberian

women and girls in their quest for treatment and a new life shows that raising

awareness about the problem is a key component to end fistula in the country.

“As we improve knowledge about fistula, we can break the cycle of poor

maternal health and stigma associated with women living with obstetric fistula,”

explained the national fistula programme manager in Liberia, Dr. John Mulbah.

Another priority is country capacity development. Before the initiative,

medical doctors would come from abroad to perform surgical interventions.

Now, most providers are from Liberia and a central outreach team led by Dr.

Mulbah goes from county to county to operate and train providers. As part

of this strategy, fistula management and treatment have been included in

the curricula of the only medical school in the country.

The results achieved in the last three years since the programme was

launched are impressive, including the steady increase in the number of

patients treated: from around 150 in 2007 to almost 200 in 2009, with an

average success rate of 81 per cent.

Working at the community level to sensitize residents about the impor-

tance of timely referral and access for women with pregnancy complications

to specialized health services is another cornerstone of the programme.

A major step is to reintegrate fistula survivors back into society after

treatment, as their communities often reject them. “It’s critical to empower

them and to work with the community so that survivors are accepted back,”

said the UNFPA Assistant Representative in Liberia, Dr. Philderald Pratt.

Sallay stands in the center with village chief and local midwife.

dispatch

Sierra Leone has one of the highest maternal mortality rates in the world.

Some 30 per cent of the deaths are caused by obstructed labour, and

although there are no official estimates on obstetric fistula in Sierra Leone,

specialists agree that the figures are high.

The urgent need for awareness-raising, strengthened health care and for

cultural changes to enhance maternal health in the country is best exempli-

fied by Sallay Jusu, a 45-year-old woman from the district of Moibayeima in

the eastern part of Sierra Leone, who lived with obstetric fistula for 25 years.

Ms. Jusu’s story is as compelling as her background — she is of the

Mendes ethnic group and a traditional chief in her own district. However,

in a land not well-accustomed to female leadership, not all clans in Sierra

Leone accept women leaders. Regardless, she uses her unusual prominence

to spread the word and mobilize society against obstetric fistula.

It doesn’t come as a surprise that Ms. Jusu didn’t know why she was

leaking after giving birth at the age of 20. Poor access to information and

health care, particularly for young people, high illiteracy rates among

women and limited information are some of the major challenges in tack-

ling maternal health problems in Sierra Leone.

She initially thought it was a punishment for her sins. Since there are

serious taboos in the country about leaking women, all related to sexual

behavior, Ms. Jusu suffered in silence for more than two decades to avoid

discrimination. Husbands usually divorce their wives when they learn they

have the condition, and women are then even more stigmatized.

UNFPA National Programme Manager for Reproductive Health in Sierra

Leone, Dr. Jarrie Kabba-Kebbay, explains that these deeply entrenched cultural

barriers not only prevent women from seeking help but also hinder efforts to

prevent new cases. “Women can’t access information or health care. More-

over, there is limited male involvement in the use of reproductive health and

an almost complete male dominance in decision-making,” she said.

“We live in a society in which women are not empowered to make their

own decisions. Their husbands or other family members decide on whether

to deliver in the health facilities or not.”

5

Finda, 23, was treated from fistula. Photo: Lisa Russell/Governess Films.

Read more: www.endfistula.org

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More than one hundred maternal health practitioners from across Africa

and Asia sent a unanimous message at the Second Conference of the

International Society of Fistula Surgeons (ISOFS): strengthening prevention

and health care delivery is paramount to eliminate obstetric fistula.

This imperative was eloquently outlined in the opening speech by

Dr. Bashir M. Isaak, who heads the Division of Reproductive Health of

Kenya’s Ministry of Public Health. He declared, “We cannot treat ourselves

out of obstetric fistula. There must be renewed effort in strengthening

safe motherhood.”

The conference held November 25-27 in Nairobi, Kenya, covered topics

ranging from the role of community midwives to the effectiveness of social

reintegration and community partnerships. Organized in collaboration

with the African Medical

and Research Foundation

(AMREF), the event hosted

a diverse assembly of

government ministries,

medical professionals, and

delegates from civil organizations and academic institutions.

As an annual summit of health care providers and activists from some of

the world’s most affected nations, ISOFS provides a valuable forum to share key

lessons from their work on the front lines of obstetric fistula.

“By sharing your experiences, you have given many women hope,” said

the Conference Chair, Dr. Asante Sana. “Each participant goes home with

a basket full of ideas. It’s my hope that these ideas will be translated to

actions towards restoration of women’s dignity.”

Ms. Batula Abdi, UNFPA Kenya Reproductive Health Programme Officer,

highlighted several measures identified as critical, including:

• Community involvement in prevention and treatment efforts,

• Generating evidence in what works better in the area of clinical

management and social integration,

• Strengthening health care systems to provide obstetrical emergency

care, and

• Harnessing community midwives to effectively communicate

prevention strategies.

ISOFS, originally led by Dr. Catherine Hamlin, co-founder of the Addis

Ababa Fistula Hospital and a pioneer in fistula surgery, is committed to

“Outcast no more”In March 2009, CNN World Report broadcast “Outcast No More,” a UNFPA-produced documentary on obstetric fistula survivors in Afghanistan’s remote Badakshan province. The video follows the story of two fistula survivors and the UNFPA-trained doctor who performed their successful surgeries. Currently available on YouTube and the UNFPA Online Video Channel, the video has since received more than 50 requests for broadcasting throughout the world.

6

MDG good practicesAs part of the Millennium Development Goal (MDG) + 10 efforts, the United Nations Development Group MDG Policy Network has developed a publication on MDG Good Practices with examples of each Millennium Development Goal and efforts to make progress toward the achievement of corresponding targets. The publication will be released in 2010.

The Campaign to End Fistula promising case example was included in the chapter addressing MDG5, the goal focused on improving maternal health and increasing universal access to reproductive health.

The Campaign case emphasizes its innovative and comprehensive approach, which combines programmatic, technical and advocacy interventions. It argues the “scalability” of the programme is facilitated by mainstreaming the issue of obstetric fistula in country sexual and reproductive health plans, and capacity strengthening at country and regional levels for obstetric fistula training, treatment and rehabilitation services.

The case reports on the three key strategic intervention points of prevention, treatment and reintegration – emphasizing the results achieved to date (at the close of the 5th year of the global Campaign).

Fistula at ECOSOCFistula survivor and activist Sarah Omega Kidangasi joined singer/actress and Campaign celebrity spokesperson, Natalie Imbruglia to call for action on maternal health and obstetric fistula at the High Level Segment of the Economic and Social Council (ECOSOC) meeting of the United Nations in July 2009.

Addressing 400 attending ministers of health, foreign affairs and ambassadors at the ECOSOC High-Level Segment, Ms. Imbruglia detailed the sobering statistics: that every minute a woman dies needlessly in pregnancy or childbirth, and that for every woman who dies, 20-30 women suffer from obstetric fistula or other devastating birth injuries. Ms. Kidangasi gave a powerful account of her own struggle with this preventable condition.

“Night and day for twelve years, my life was continually put on the verge,” she recalled. “With uncontrolled leaking of urine, foul smell, stigma, isolation, pain and rejection, it was like dying every day.” Ms. Kidangasi testimony and strong presence helped raise the profile of maternal health within the context of the meeting, exemplifying the importance of empowering fistula survivors.

Fistula surgeons call for initiativesNairobi, Kenya

eliminating fistula globally through prevention and curative activities in

partnership with member countries’ societies. The organization held its

first conference in Addis Ababa, Ethiopia, in 2008. Renowned fistula surgeon

Dr. Kees Waaldijk currently serves as President.

Read more: www.endfistula.org

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Following the success in the United States, “Congo/Women Portraits of War:

The Democratic Republic of Congo” recently premiered in Europe with mas-

sive attendance. The critically acclaimed photography exhibition features

images by award winning photographers Lynsey Addario, Ron Haviv, Marcus

Bleasdale and James Nachtwey.

The European launch event, carried out in the United Nations Palais in

Geneva, marked the start of the exhibition’s European tour and commemo-

rated both International Women’s Day (8 March) and the 15th anniversary

of the adoption of the Beijing Declaration and Platform for Action.

According to Adele Kagarabi, provincial commissioner, advisor to the

government of South Kivu and strong advocate for an end to violence

against women, “the awareness-raising campaigns that we implement at

national and local level together with UNFPA and other partners help to

make people aware of the problem and about their rights.”

“As you walk between the poignant portraits of this exhibition, I hope

you will each think of one thing you can personally do to help women in

the DRC,” she said and ended on a note of hope, pointing out that since

2004 UNFPA-supported programmes had brought health and legal help to

thousands of survivors.

The exhibit features both photographs and essays documenting the

bravery of women and their families through the recent atrocities they

endured in the Democratic Republic of Congo: the violent passage from

dictatorship to democracy, ongoing economic crises, ethnic struggles and

all kinds of violence.

These challenges have been accompanied by the nearly total collapse

of the health system and an almost complete absence of both general and

reproductive health care, and the common occurrence of rape and extreme

sexual violence against women and girls of all ages with devastating

consequences — obstetric and traumatic fistula among them. For those who

survived, support was often unavailable.

The exhibit, organized by the Art Works Projects (Art and Design for Human

Rights) and the Ellen Stone Belic Institute for the Study of Women and Gender

in the Arts and Media, Columbia College in Chicago, was funded by UNFPA,

Humanity United, and Leadership donors of the Ellen Stone Belic Institute.

Series of pictures depicts the challenges faced by Congolese women. Photo: UNFPA Geneva.

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An external, mid-term review of the global Campaign to End Fistula was

conducted in 2009. The review assessed eight country level programmes,

as well as global and regional support provided to countries.

The evaluation, led by a team from Health Research for Action

(HERA) & the International Center for Reproductive Health (ICRH), had

two main objectives:

Assess the relevance, effectiveness and efficiency of the current

strategies and approaches for national fistula programming.

Assess the coordination, management and support from UNFPA’s

global and regional levels to national level efforts.

It was a comprehensive evaluation focusing on the UNFPA supported

elements of the Campaign. The major findings were reported in

10 volumes: eight country-related, one summarizing the country

findings and one focusing on global and regional level activities.

Some of the major findings of the evaluation include:

The Campaign to End Fistula has achieved a lot in terms of

awareness building and service development. It has been a catalyst

to mobilise countries towards addressing fistula prevention,

treatment and care;

Within UNFPA the internal coordination and management mechanisms

for the Campaign contributed not only to increased coordination and

ownership of activities but also to greater knowledge of obstetric

fistula, both inside the organization and with external audiences;

The global advocacy and awareness raising activities have been a key

contributor to greater visibility and knowledge of the fistula problem

at global and national levels, as well as resource mobilisation for

fistula programmes both within and outside UNFPA;

It is essential to increase integration of fistula prevention, treatment

and care into UNFPA country programmes and into national

reproductive health programmes.

Since integration carries the risk that the achievements of the Campaign

in creating public awareness and political support may gradually be lost,

it is necessary to maintain the specific focus on advocacy, monitoring

and technical assistance at the global, regional and national levels.

The findings contribute to the evidence base about effectiveness of

approaches in fistula-related programming used to date and increase

understanding of how the Campaign approach, with multiple strategies

undertaken simultaneously at national, regional and global levels has

assisted in advancing the programme.

Results and recommendations will be disseminated to partners

and donors in 2010, providing important guidance for the future of

the Campaign. The countries surveyed were: Bangladesh, DRC, Niger,

Nigeria (in-depth assessments) and Kenya, Pakistan, Sudan, and

Tanzania (desk reviews).

Campaign mid-term reviewPortraits of warGeneva, Switzerland

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UNFPACampaign to End Fistula220 E. 42nd Street, New York, NY 10017email: fistulacampaign@unfpa.org

dispatch is a biannual newsletter highlighingdevelopments in the Campaign to End Fistula

Why the Campaign?

Over 300 million women worldwide suffer from complications of pregnancy and delivery. For every woman who dies, at least 20 experience a maternal morbidity, including obstetric fistula.

Obstetric fistula is a preventable and treatable childbearing injury that leaves women incontinent, ashamed and often isolated from their communities.

There are at least 2 million women living with obstetric fistula in the developing world and up to 100,000 new cases occur each year.

In 2003, UNFPA and its global partners united to launch the Campaign to End Fistula.

Since then, the Campaign is now present in 47 countries, raising over US$37 million toward the goal of eliminating fistula by the year 2015.

The Campaign, with its many partners around the world, focuses on three key areas: preventing fistula, treating affected women, and supporting women as they recover from surgery and rebuild their lives.

For more information or to learn how you can help, please visit: endfistula.org.

Campaign to End Fistula Countries

Caribbean

Editorial Process: Etienne FrancaDesign and Printing: Prographics, Inc.

Contributors:Leyla Alyanak, Hashina Begum, Michel Brun, Nicole Carta, Jacqueline Daldin, Luc De Bernis, Christian Del Sol, Triana Dorazio, Katherine Gifford, Calixte Hessou, Katja Iversen, Janet Jensen, Jarrie Kabba-Kebbay, Dimitry Leger, Cecile Mazzacurati, Geoffrey Okumu, Amanda Patterson, Friederike Paul, Sehar Raja, Kate Ramsey, Lisa Russell, Julie Weber, Anne Wittenberg.

Campaign Donors (since 2003)Americans for UNFPAArab Gulf Programme for UN Development Organizations Bill & Melinda Gates Foundation through EngenderHealth European Voice Government of AustraliaGovernment of AustriaGovernment of Canada Government of FinlandGovernment of IcelandGovernment of Ireland Government of Japan (through the UN Trust Fund for Human Security) Government of LuxembourgGovernment of New Zealand Government of the NetherlandsGovernment of Norway Government of Poland Government of the Republic of Korea Government of Spain Government of SwedenGovernment of SwitzerlandJohnson & Johnson Kingdom of Spain, Autonomous Community of CatalunyaOne by One United Nations FoundationVirgin UniteWomen's Missionary Society of the African Methodist Episcopal ChurchZonta International UNFPA wishes to acknowledge with gratitude the multi-donor support generated towards strengthening and improving Maternal Health in the world. Our appreciation is also extended to the many partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.

The global conference Women Deliver is expected to draw thousands of committed advocates for global sexual and reproductive health to Washington DC from June 7-9. Building upon the historic success of the inaugural conference in 2007, this event will give platform to a dynamic international slate of speakers and panelists to address core themes of Maternal and Newborn Health, Health of Women and Girls, Family Planning, and Culture. In this spirit of inclusiveness, Women Deliver 2010 will send a strong, clear message to the world’s nations: that maternal and reproductive health is a global priority.

Inadequate sexual and reproductive care accounts for an estimated one-third of the global burden

of illness and early death among women of reproductive age. The Maternal Health Advocates Panel,

organized by UNFPA, will address the human scale of this staggering statistic, from the perspective

of champions journeying from different countries

around the world. The panel will give voice to these

heroes who work bravely and tirelessly to effect

lasting social change in their communities,

and beyond.

Each panelist will share the story of her own struggle with reproductive health issues (including

obstetric fistula, adolescent pregnancy, and HIV/AIDS) and the frequently corresponding stigma

associated with these conditions. Through their commitment and passion, these women

transformed personal challenges into a catalyst for positive change within their community.

The Panel seeks to facilitate increased, equitable access to the global stage for these advocates,

advancing development by respecting their rights to engage in dialogue about decisions affecting

their lives and lives of others with similar stories and circumstances. It will also provide a rare

forum for peer exchange of skills and lessons learned with other advocates. Leading by example,

these champions will lend their voices to the call for investment in the world’s women.