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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.
Plan of action for the eradication of harmful traditional practices affecting the health of women and children in Africa.
[Unpublished] 1987. 14 p.The traditional and harmful practices such as early marriage and pregnancy, female circumcision, nutritional taboos, inadequate child spacing, and unprotected delivery continue to be the reality for women in many African nations. These harmful traditional practices frequently result in permanent physical, psychological, and emotional changes for women, at times even death, yet little progress has been realized in abolishing these practices. At the Regional Seminar of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children in Africa, held in Ethiopia during April 1987, guidelines were drawn by which national governments and local bodies along with international and regional organizations might take action to protect women from these unnecessary hazardous traditional practices. These guidelines constitute this "Plan of Action for the Eradication of Harmful Traditional Practices Affecting the Health of Women and Children in Africa." The plan should be implemented within a decade. These guidelines include both shortterm and longterm strategies. Actions to be taken in terms of the organizational machinery are outlined, covering both the national and regional levels and including special support and the use of the mass media. Guidelines are included for action to be taken in regard to childhood marriage and early pregnancy. These cover the areas of education -- both formal and nonformal -- measures to improve socioeconomic status and health, and enacting laws against childhood marriage and rape. In the area of female circumcision, the short term goal is to create awareness of the adverse medical, psychological, social and economic implications of female circumcision. The time frame for this goal is 24 months. The longterm goal is to eradicate female circumcision by 2000 and to restore dignity and respect to women and to raise their status in society. Also outlined are actions to be taken in terms of food prohibitions which affect mostly women and children, child spacing and delivery practices, and legislative and administrative measures. Women in the African region have a critical role to play both in the development of their countries and in the solution of problems arising from the practice of harmful traditions.
Chapel Hill, North Carolina, Institute for Development Training, 1986. 42,  p. (Training Course in Women's Health Module 5)Female circumcision encompasses a variety of surgical procedures performed on female children in Africa and the Middle East. Although female circumcision is a traditional practice, it is also a health issue because of its severe physical and psychological consequences. This women's health module seeks to provide health practitioners with information on recognizing the immediate and longterm consequences of female circumcision and to suggest ways of counteracting this practice. The module includes a pre-test and post-test and chapters on the following topics: types of female circumcision operations, immediate health effects of the practice, longterm consequences for general health, the effects of excision and infibulation on marriage and childbirth, health consequences of re-infibulation, and health education strategies. The module is self-instructional, allowing the student to learn at his or her own pace. An appended statement by the World Health Organization (WHO) states that WHO has consistently and unequivocally advised that female circumcision should not be practiced by any health professionals in any setting.
WHO CHRONICLE. 1986; 40(1):31-6.A traditional practice that has attracted considerable attention in the last decade is female circumcision, the adverse effects of which are undeniable. 70 million women are estimated to be circumcised, with several thousand new operations performed each day. It is a custom that continues to be widespread only in Africa north of the equator, though mild forms of female circumcision are reported from some Asian countries. In 1979 a Seminar on Traditional Practices that Affect the Health of Women and Children was held in the Sudan. It was 1 of the 1st interregional and international efforts to exchange information on female circumcision and other traditional practices, to study their implications, and to make specific recommendations on the approach to be taken by the health services. There are 3 main types of female circumcision: circumcision proper is the mildest but also the rarest form and involves the removal only of the clitoral prepuce; excision involves the amputation of the entire clitoris and all or part of the labia minora; and infibulation, also known as Pharaonic circumcision, involves the amputation of the clitoris, the whole of the labia minora, and at least the anterior 2/3 and often the whole of the medial part of the labia majora. Initial circumcision is carried out before a girl reaches puberty. The operation generally is the responsibility of the traditional midwife, who rarely uses even a local anesthetic. She is assisted by a number of women to hold the child down, and these frequently include the child's own relatives. Most of the adverse health consequences are associated with Pharaonic circumcision. Hemorrhage and shock from the acute pain are immediate dangers of the operation, and, because it is usually performed in unhygienic circumstances, the risks of infection and tetanus are considerable. Retention of urine is common. Cases have been reported in which infibulated unmarried girls have developed swollen bellies, owing to obstruction of the menstrual flow. Implantion dermoid cysts are a very common complication. Infections of the vagina, urinary tract, and pelvis occur often. A women who has been infibulated suffers great difficulty and pain during sexual intercourse, which can be excruciating if a neuroma has formed at the point of section of the dorsal nerve of the clitoris. Consummation of marriage often necessitates the opening up of the scar. During childbirth infibulation causes a variety of serious problems including prolonged labor and obstructed delivery, with increased risk of fetal brain damage and fetal loss. A variety of reasons are advanced by its adherents for continuing to support the practice of female circumcision, but the reasons are rationalizations, and none of the reasons bear close scrutiny. The campaigning against female circumcision is reviewed.
Lexington, Massachusetts, Women's International Network News, 1982 Nov. 338 p.This report documents the existence and prevalence in Africa and in other regions of the world of the cultural practice of female circumcision and genital mutilation (FC/GM). This serious problem is examined so that it can be abolished. Until recently the problem was hidden from the public, and most health, government and international agency officials denied that the practices were widespread. In 1979 at a World Health Organization (WHO) seminar on traditional health practices, the problem received international attention. Recommendations made by the seminar participants urged nations to adopt policies to abolish FC/GM, to establish commissions to coordinate activities aimed at abolishing the practices, and to intensify efforts to educate the public and health professionals about the problem. In 1984 it was estimated that 79.97 million women in Africa had FC/GM operations performed at some time during their life. The proportion of women who have had FC/GM operations was almost 100% in Somalia, 90% in Ethiopia, 80% in Sudan, Mali, and Sierra Leone, and 60% in Kenya, Ivory Coast, and Gambia. Information is provided on 1) the extent of the practices, 2) the health problems associated with FC/GM, 3) the 1979 WHO seminar, 4) the history of FC/GM, and 5) the cultural beliefs supporting the practices. Case histories provide detailed information on the practices in 11 African countries, 4 countries on the Arab Pennisula, and 2 Asian countries, including Sudan, Somalia, Egypt, Ethiopia, Kenya, Nigeria, Mali, Upper Volta, Senegal, Ivory Coast, Sierra Leone, People's Democratic Republic of Yemen, Oman, United Arab Emirates, Bahrain, Indonesia, and Malaysia. The existence of FC/GM practices in many other countries, including Western nations, is also documented. These practices are also discussed in reference to the depressed status of women in many African countries, and the role of women in these countries is examined in regard to legal matters, education, employment, agriculture, family planning, development, and urbanization. Political factors hindering the abolition of the practices and the hesitancy of international agencies such as WHO, US Agency for International Development, and the UN Children's Fund, to deal with the problem are discussed. There is some evidence that FC/GM operations are being conducted in hospitals in a number of African countries, and efforts must be made to prohibit the introduction of these practices into the modern health care system. Suggestions are provided for action and education programs aimed at abolishing FC/GM practices. An annotated bibliograpy, containing 78 references, is also provided.