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“I was depressed and ashamed to interact with friends and relatives because of fistula. My husband who was my source of support told me at one point that he almost abandoned me. I was not a happy woman as a result of this [fistula] predicament,” recollected 38-year-old Maseray Bangura, a petty trader from Mambolo, a chiefdom headquarter town in the Kambia district.

Obstetric fistula, a childbirth injury wherein a hole develops between the birth canal and the urinary system resulting in constant leakage of urine or faeces is often the direct result of failure by a health system to provide quality health care during childbirth.

Women who develop fistula often have prolonged labour due to the failure to make a timely decision to go to the health facility when labour starts, or a delay in reaching a health facility due to a poor referral system or bad road network, or the failure of a health facility to provide timely and apt treatment to women during childbirth.

Approximately 2 million women currently live with fistula globally. In 2003, in line with universal targets to advance maternal and newborn health and with the goal of making fistula as rare as possible, UNFPA, the United Nations’ sexual and reproductive health agency, and its partners, launched a global campaign to end fistula.  Sierra Leone, estimated to have 2,400 women living with obstetric fistula, is among the 55 nations participating in the global campaign.

Pregnant with her fifth child, Maseray Bangura was taken for her delivery to the Government Hospital in Lungi, a referral hospital in Port Loko district. There, she encountered difficulties and was unable to deliver the baby.

“For three agonizing days, I was experiencing severe labour pain. Clearly I was unable to deliver my baby. The nurses told me I was not having enough blood. It was a difficult moment for me. To save my life and that of the baby, a caesarean delivery was performed successfully and few days later, I was discharged,” she narrated her ordeal.

With 717 deaths per 100,000 live births, according to the 2019 Demographic and Health Survey, Sierra Leone is still among countries with the world’s highest maternal mortality ratio. Bleeding in pregnancy (obstetric haemorrhage) accounts for about 40 per cent of maternal deaths in the country. 

Safe pregnancies and childbirth depend on functioning health systems and provision of quality care. In Sierra Leone, therefore, UNFPA is addressing fistula prevention (as well as prevention of maternal and newborn mortality and morbidity, and stillbirth, and improving the quality of maternal care) by supporting the Ministry of Health and Sanitation in improving quality services for pregnant and postnatal women.

When Maseray was discharged a week later, she realized she had developed serious complications, having returned home with fistula. “Four days after returning home, I realized I was leaking urine unconsciously. This was too much for me. It was a shameful thing to experience.  I chose not to tell anyone and only confined it to my husband and my mother,” she revealed with sadness.

Obstetric fistula is preventable and in most cases can be repaired surgically. In Sierra Leone, with funding from the Government of Iceland, UNFPA partners with non-governmental organizations like Haikal Foundation and Aberdeen Women’s Centre to conduct screening for women with suspected obstetric fistula, and surgery to repair their fistula and restore their dignity. UNFPA also supports the government in preventing the incidence of obstetric fistula by strengthening the quality of obstetric services, a key component to addressing maternal mortality.

In 2020, for instance, 260 women were screened for suspected obstetric fistula. Of these women, 129 had surgery to repair their fistula, with 31 of them receiving livelihood skills as part of their rehabilitation and reintegration. Since 2011 to date, Aberdeen Women’s Centre, with funding support from UNFPA, has successfully performed 1,731 fistula surgeries.

When Maseray learned of the work of Aberdeen Women’s Centre, she travelled to Freetown with her husband to be admitted at the centre for her fistula surgery.

“I successfully underwent the surgery without paying a cent. I have seen so much improvement and I am beginning to gain my happiness and self-confidence. My dignity has been restored. I have spent a week without experiencing urine leaks.  My wish now is to return to my hometown because I am not leaking anymore.”

Distributed by APO Group on behalf of United Nations Population Fund (UNFPA).