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Improving care for women with obstetric fistula: new WHO recommendation on duration of bladder catheterisation after the surgical repair of a simple obstetric urinary fistula.
BJOG. 2018 Nov; 125(12):1502-1503.Under the Sustainable Development Goals (SDGs) and universal health coverage, the "survive, thrive, transform" agenda moves beyond reducing mortality and focuses on the importance of maternal morbidity.((1) ) An obstetric fistula, one of the most devastating types of maternal morbidity, is usually caused by injury during childbirth from prolonged or obstructed labour. The prolonged compression of the fetal head against the pelvic bones can cause ischaemic necrosis of parts of the bladder, urethra or vagina, resulting in an abnormal opening between a woman's genital tract and her urinary tract that leads to the continuous flow of urine through the vagina.((2)) Women with obstetric urinary fistula are often faced with serious social problems including abandonment by their partners, families and communities mainly due to persistent odour of urine as they are constantly wet and unable to control their urinary function.((3)) While these fistulae are almost non-existent in high-income countries, it remains a public health problem that affects over one million women, their families and communities in Sub-Saharan Africa and South Asia with poorly-resourced health systems and inadequate intrapartum care services. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
New York, New York, UNFPA, .  p.UNFPA's Maternal Health Thematic Fund, initiated in early 2008, represents a focused effort to accelerate progress towards saving women's lives and achieving universal access to reproductive health, as outlined in Millennium Development Goal 5. This report outlines the activities, results and achievements from 2010 and looks ahead at future challenges. It also features results from the Campaign to End Fistula and the ICM-UNFPA midwifery project and illustrates that significant progress can be made by adopting proven strategies -- including family planning, skilled care during childbirth, and expanded access and utilization of emergency obstetric and newborn care -- combined with partnerships for better coordination under national leadership.
[New York, New York], United Nations, General Assembly, 2008 Aug 6. 20 p. (A/63/222)The present report was prepared in response to General Assembly resolution 62/138. Obstetric fistula is a devastating childbirth injury that leaves women incontinent and often isolated from their communities. It is a stark example of continued poor maternal and reproductive health services and an indication of high levels of maternal death and disability. The report outlines efforts to end obstetric fistula at international, regional and national levels, including by the United Nations system. It concludes with recommendations to intensify efforts to end obstetric fistula as part of support to the achievement of Millennium Development Goal 5, including strengthening health systems and increasing levels and predictability of funding.
[New York, New York], United Nations Population Fund [UNFPA], 2008. 35 p.Obstetric fistula, almost unknown in the industrialized world, is most common in poor communities of sub-Saharan Africa and Asia where emergency obstetric care is rarely accessible. It occurs when a woman undergoes a difficult and prolonged labour without prompt medical intervention. Left incontinent, women with fistula are often abandoned by husbands and loved ones and blamed for their condition. Their babies are usually born dead. Like maternal death, obstetric fistula is preventable. Averting it will also contribute to safer childbearing for women throughout the developing world.This publication covers topics such as: 1. Advancing Maternal Health and Rights; 2. Preventing Harm; 3. Healing Wounds; 4. Renewing Hope; 5. Harnessing Momentum.
The Fistula Fortnight: Healing Wounds, Renewing Hope, 21 February - 6 March 2005, Kano, Katsina, Kebbi and Sokoto States, Nigeria.
New York, New York, United Nations Population Fund [UNFPA], . 46 p.The Fistula Fortnight accomplished a number of goals: it mobilized resources for obstetric fistula and safe motherhood; increased public awareness that fistula is preventable; contributed to combating the marginalization of women who suffer from fistula; strengthened institutional capacity to manage fistula; and began to address the broader needs of women living with the disability. While the surgeries conducted represent only a small portion of the backlog, the Fistula Fortnight provided a strategic opportunity to raise awareness and motivate action among policymakers, national and local leaders, and the general public about the need to increase efforts to both prevent and treat fistula. (Excerpt)
New York, New York, Family Care International, 2007.  p.This publication explores knowledge, attitudes, and perspectives on pregnancy, delivery, and fistula from 31 country-level needs assessments conducted in 29 countries in the Campaign to End Fistula (see inside back cover for the complete list). Experiences of women living with obstetric fistula, their families, community members, and health care providers are brought to light. This information represents important research on the social, cultural, political, and economic dimensions of obstetric fistula, drawing attention to the factors underlying maternal death and disability. We hope this publication will serve as an advocacy tool to strengthen existing programmes and encourage further research on how to increase access to vital maternal health services, including fistula prevention and treatment. We implore policy makers, programmers, and researchers to listen to these women's voices and consider the promising practices and strategic recommendations described herein. What we have learned so far can help point the way, but much more still needs to be done. We cannot afford to wait-the costs to women, communities, and health systems are simply too great to delay action. Too many of the world's most disadvantaged and vulnerable women have suffered this preventable and treatable condition in silence. Too many women are dying unnecessarily in childbirth. It is time to put an end to the injustice of fistula and maternal death. (author's)
Obstetric fistula: Guiding principles for clinical management and programme development, a new WHO guideline.
International Journal of Gynecology and Obstetrics. 2007 Nov; 99 Suppl 1:S117-S121.It is estimated that more than 2 million women are living with obstetric fistulas (OFs) worldwide, particularly in Africa and Asia, and yet this severe morbidity remains hidden. As a contribution to the global Campaign to End Fistula, the World Health Organization (WHO) published Obstetric fistula: Guiding principles for clinical management and programme development, a manual intended as a practical working document. Its 3 main objectives are to draw attention to the urgency of the OF issue and serve as an advocacy document for prompt action; provide policy makers and health professionals with brief, factual information and principles that will guide them at the national and regional levels as they develop strategies and programs to prevent and treat OFs; and assist health care professionals as they acquire better skills and develop more effective services to care for women treated for fistula repair. (author's)
BMJ. British Medical Journal. 2006 Jul 1; 333(7557):8.Hundreds of thousands of women in developing countries suffer the devastating injury during child bearing of obstetric fistula. But the agency behind a global campaign to eradicate the condition says it is simple to prevent and easy to treat. The global campaign, led by the international development agency the United Nations Population Fund, has launched a month long advertising drive in the United Kingdom to raise awareness of a condition that is believed to affect between 50 000 and 100 000 women each year. Obstetric fistula is usually caused by several days of obstructed labour without prompt medical intervention and leaves the woman with agonising, long term pain, chronic incontinence, and--in most cases--a stillborn baby. (excerpt)
Lancet. 2003 Dec 31; 363(9402):71-72.The advent of modern obstetric care has led to the eradication of obstetric fistula in nearly every industrialized country. However, in the developing world obstetric fistula continues to cause untold pain and suffering in millions of women. The very existence of this condition is the result of gross societal and institutional neglect of women that is, by any standard, an issue of rights and equity. In the developing world, obstetric fistula is almost always the result of obstructed labour. During prolonged obstructed labour the soft tissues of the pelvis are compressed between the descending baby’s head and the mother’s pelvic bone. The lack of blood flow to these tissues leads to necrosis and ultimately a hole forming between the mother’s vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal), or both, that leaves her with urinary or faecal incontinence, or both. Early intervention to relieve obstructed labour will restore perfusion to these tissues and, in most cases, will prevent fistula. The results of fistula are devastating. In nearly every case the baby is stillborn. Women and girls with fistula are unable to stay dry. They smell of urine or faeces and are shunned by the community and, at times, even by their own husbands and families. They remain hidden, shamed, and forgotten. (excerpt)
The second meeting of the Working Group for the Prevention and Treatment of Obstetric Fistula, Addis Ababa, 30 October -1 November, 2002.
New York, New York, UNFPA, 2003. 38 p.Much of the meeting was devoted to presentation of needs assessments from 12 African countries. Nine countries were surveyed by Engender Health; the African Medical and Research Foundation surveyed Kenya; and the Women’s Dignity Project assessed the situation in Tanzania. Dr. Catherine Hamlin and Ruth Kennedy also presented information about the situation in Ethiopia. The assessments provide a clear and informed base—for the first time—on which to build a realistic plan of action to combat fistula in the region. This information should also help to bring the tragedy of fistula out from under its shroud of shame and secrecy. We expect this will result in increased support for many of the best programmes already in place in Africa and in the creation of a regional network for fistula prevention and treatment. (excerpt)
International Journal of Gynecology and Obstetrics. 2003 Sep; 82(3):357-367.The International Federation of Gynecology and Obstetrics – FIGO – has been striving hard to carefully attend to women’s well-being, and respect and implement their rights, the status and their health, which is well beyond the basic obstetric and gynecological requirement. FIGO is deeply involved in acting as a catalyst for the all-round activities of national obstetric and gynecologic societies to mobilise their members to participate in and contribute to, all of their endeavours. FIGO’s committees strengthen these objectives and FIGO’s alliance with WHO provides a springboard. The task is gigantic, but FIGO, through national obstetric and gynecological societies and with the strength of obstetricians and gynecologists as its battalion, can offer to combat and meet the demands. (author's)