Senegal: Free treatment for obstetric fistula

President Abdoulaye Wade has ordered his government to allow free treatment for women suffering from obstetric fistula - often a result of early childbirth that leaves young women incontinent and sometimes shunned by their communities.
In a meeting with women in the northern region of Saint-Louis earlier this month, Wade likened early marriage to rape.
"It is unacceptable to marry 13-year-old girls and I will apply the constitution to formally ban these types of marriages," Wade said after watching a film on obstetric fistula.

The legal age of marriage in Senegal is 18. In impoverished communities across Africa, Asia and Latin America, parents will consent to early marriage for their daughters in exchange for a dowry.

Early marriage invariably leads to early sexual contact and early pregnancy.

Obstetric fistula is a tearing injury of childbearing that is usually caused by prolonged, obstructed labour. A caesarean section normally would be performed to relieve the pressure of the baby pushing down on the abdomen, but the procedure is costly and requires access to good medical care.

Without such intervention the baby usually dies and the woman is unable thereafter to control her flow of urine or faeces.

"It is a terrible problem," said Dr. El-Hadji Ousseynou Faye, head of Maternal Health for Senegal. "The behaviour of a community varies from one area to another, from one ethnic group to another. In some cases, the victims are obliged to isolate themselves, deserted by their husbands. In other cases they are accepted."

Without treatment, the woman's prospects for work and family life are greatly diminished, and she is often left to rely on charity. The UN Population Fund launched a campaign to combat obstetric fistula in 2003.

The World Health Organisation estimates that about two million women in developing countries suffer from the problem and that between 50,000 and 100,000 new cases occur annually around the world.

In Senegal, treatment for the injury costs more than US $200, which approaches the average annual income of many African households.

"The cost varies according to the hospital and the cases. The (amount) is an average for the simple cases, but in complicated cases that need a lot of intervention it can be a lot more costly," said Dr. Faye.

He said Senegal had no national strategy to combat obstetric fistula. Such an undertaking would require raising awareness in communities and among healthcare workers, collecting data and taking care of victims.

Medical workers say it is difficult to know how many women in Senegal struggle with the problem because they usually suffer in silence at home.

Radical forms of female genital cutting, or circumcision, such as the Gishiri cut and infibulation, can also cause obstructed labour and result in obstetric fistula.

The Gishiri cut, which is practiced in northern Nigeria, can leave a hole between the bladder and the vagina. Infibulation is the stitching up of the vagina.

Many efforts are underway across Africa to educate communities about the risks of genital cutting. Several governments have banned the practice but enforcement is often weak.

July 18, 2006