Interview with Dr. Afrah Thabet, Reproductive Health Analyst, UNFPA Yemen
• What are the main causes of fistula, and what makes it prevalent in Yemen?
It is usually caused by obstructed labour which takes several days, without timely medical intervention – such as a Caesarean section to relieve the pressure. In Yemen with the current war/ conflict situation with the breakdown of the health system; most of the health facilities are destroyed andwith lack of skilled birth attendance, most of the pregnant women prefer to deliver at home. Increasing giving birth without any qualified assistance, fistula cases are expected to be increase dramatically. Child marriage and early pregnancy, malnutrition are the most causes of obstetric fistula.
• How big is the role of social norms and pressure in the prevalence of fistula?
The social norms play an important role in the prevalence of obstetric fistula due to poverty which is the main underlying factor especially with the current war and conflict situation, It is associated with child marriage and malnutrition, education and lack of funds that hinders a woman from access to emergency obstetric care, as well as deterioration of the health system and lack of skilled birth attendance in the rural area. Consequently, due to cultural aspect,young and poor women living in rural areas are particularly at risk prefer home delivery. Because of their low status in their communities, women often lack the power to decide or choose when to start bearing children or where to give birth.
• What programs are you engaged in to end fistula?
UNFPA’s flagship accomplishment in Yemen is that it supported the establishment of two fistula units, one in the capital Sana’a covering the cases coming from Northern areas and the second unit in Al-Sadaka hospital in Aden governorate covering the cases coming from the South areas. In addition, UNFPA has created and strengthened a network between community volunteers, community midwives(through Midwife Association), reproductive health and fistula experts from most of the governorates to help women suffering from fistula get services at the fistula units. UNFPA also supported health education programme to end fistula through airing radio messages and producing various information material to spread awarness within society.
In an emergency situation such as in Yemen today, fistula in part of UNFPA’s humanitarian response work, as we prioritize access to reproductive health services and maternal care even during crisis situations.
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Interview with Dr Eqbal Nagi, Fistula surgeon at UNFPA-supported Unit, Al-Sadaka Hospital, Aden-Southern Yemen
• What are the main causes of fistula, and what makes it prevalent in Yemen?
The main causes of fistula are obstructed labour and iatrogenic trauma to the bladder or ureter during emergency caesarean section. It is prevalent in our country due to multiple factors includes the following :
Early age of marriage
Delay in access to emergency obstetric care
Delay in diagnosis of obstructed labour
Lack of skills in performing emergency caesarean section
• How big is the role of social norms and pressure in the prevalence of fistula?
Social practices play a major role in the prevalence of fistula because of the early age of marriage of girls in Yemen, an age where their pelvis and genital organs are not yet mature enough to accommodate the immense physical pressure of intimate relations and pregnancy, often even several closely spaced pregnancies. In addition, the widely practiced delivery at home, away from skilled medical care, is a major cause for fistula, as there is generally no access, when delivering at home, to emergency obstetric care, or to the possibility for an emergency caesarean section in case of obstructed labor or other complications.
• What can be done to reduce or end obstetric fistula?
It takes concerted efforts, at the national and international level, to bring an end to fistula. At the national level, the government, including the Ministry of Health, should work closely with non-governmental organizations and community leaders to try to change certain social practices such as early marriage and lack of access to informed family planning. In addition, national medical centres should be equipped with trained fistula surgeons , nurses and social workers, who will be able to react quickly during a complicated labor in order to avoid or limit the damage on the mother, or be able to repair the damage done by obstetric fistula. Women must be able to receive free-of-charge quality maternal services, including C-sections, which can save their lives during labor.
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Interview with Dr. Belqis Al-Jailani, Fistula surgeon at the UNFPA-supported Unit, Al-Thawrah Hospital, Sana’a, Northern Yemen
• What are the main causes of fistula, and what makes it prevalent in Yemen?
There are a number of factors that can lead to the very painful condition of obstetric fistula, including obstructed labor, complications due to abortions, accidental injury during pelvic surgery, cancer, direct trauma, infections like tuberculosis, TB, radiotherapy and also congenital reasons.
• What can be done to reduce or end obstetric fistula?
We can prevent and reduce occurrence fistula in our community by ensuring: Every woman has an access to reproductive Health services, family planning, skilled attendance at birth and emergency obstetric care. Rising awareness about fistula treatment services so women suffering from this hidden heartbreak issue can be helped.
The key to end obstetrical fistula is to prevent it from happening in the first place. Besides, having skilled attendance at birth, trainingdoctors to do Caesarian section of obstructed labour occur on time, and train more doctors to repair fistula.
• What programs are you engaged in to end fistula?
I am a member of The International Society of Fistula Surgeons (ISOFS) and representative of Middle East in Exo committee of ISOFS. Through UNFPA, I was trained to repair fistula. The expert that UNFPA brought taught us how to repair different types of fistula. It was very useful.
• What are the 2-3 main pieces of advice you can give a mother about preventing fistula for her daughter?
The healthier a person is, the less she is prone to any health problems generally, but young girls, with their growth still incomplete, are particularly prone to complications such as fistula. Delaying marriage and pregnancy until a young body is strong enough for this transformative event is the best protection, so not before a young woman is 18 years old. If married earlier, then a young woman should try to delay her first pregnancy. When pregnant, then a young woman must have regular antenatal care and she should deliver at a health centre providing emergency obstetric care.
