Technical Areas

USAID Activities to Prevent Fistula

A number of USAID’s maternal health activities can help reduce the occurrence of obstetric fistula. The focus is on prevention rather than later surgical repair. Prevention activities are integrated into USAID’s population and health assistance initiatives and have a number of elements:

• Increased access for women to emergency obstetrical care. If labor is prolonged or obstructed, a mother needs access to a trained surgeon who can deliver the child without harming her reproductive organs. To increase this access, USAID programs support community preparation for emergencies, strengthen referral systems to appropriate care facilities, and promote policy development to reduce financial barriers that prevent women from seeking treatment.
  


• Public awareness. USAID supports public awareness campaigns that urge women in developing countries to postpone marriage and childbearing until after the teenage years. USAID research has shown that fistula occurs disproportionately in girls who are less than 15 years old. Postponing the age of first birth will help reduce the number of fistula cases.
  


• Community training. Training for community members who are usually present at or assist in childbirth can teach them to recognize the danger signs of prolonged labor, which can lead to obstructed labor and fistula.
  


• Increased attendance of skilled personnel at delivery. Giving birth without skilled personnel in attendance is a risk factor for fistula. Pregnant women are urged to have skilled birth attendants help them when they are giving birth. Skilled attendants are taught to use a partogram to quickly identify prolonged labor and take needed action to prevent obstructed labor, which may involve transferring the woman to a higher level of obstetric care.
  


• Advocacy and awareness. Finally, USAID raises awareness to advocate for increased attention to fistula and action against it. For example, USAID commissioned the Population Reference Bureau publication Hidden Suffering: Disabilities from Pregnancy and Childbirth in Less Developed Countries, which highlights obstetric fistula. A number of other USAID partners are helping to address fistula as well.

USAID's Obstetric Fistula Strategy

Obstetric Fistula: A Devastating Injury