Dear Editor,
Obstetric fistula is a condition that occurs during prolonged and obstructed labor, leading to a hole between the birth canal and the bladder or rectum. This devastating injury often results in chronic incontinence, leaving women socially isolated, stigmatized, and facing significant physical and psychological distress (1). Additionally, women with obstetric fistula often experience challenges in accessing appropriate medical care and face limited economic opportunities (2, 3). Obstetric fistula, a devastating childbirth injury, continues to be a widespread problem in Somalia, causing immense suffering for women and girls (2). Despite the government's and various organizations' efforts, the prevalence of obstetric fistula remains alarmingly high in Somalia, highlighting the need for sustained and targeted interventions to address this issue.
In Somalia, obstetric fistula is particularly prevalent due to a combination of factors. The country has experienced decades of conflict, political instability, and limited access to quality healthcare services, all contributing to the high incidence of obstetric complications (4). The lack of skilled birth attendants, inadequate emergency obstetric care, and limited awareness about the condition further exacerbate the problem (5).
Efforts to address obstetric fistula in Somalia have been ongoing, with governmental and non-governmental organizations working tirelessly to provide treatment, raise awareness, and improve maternal health services (4). The Somali government has prioritized maternal healthcare, recognizing the importance of preventing and treating obstetric fistula. Policies and programs have been implemented to strengthen healthcare infrastructure, train professionals, and promote safe delivery practices (6).
International organizations and NGOs have also played a crucial role in supporting initiatives to tackle obstetric fistula in Somalia. They have provided funding, technical assistance, and expertise to expand access to treatment, improve surgical capacity, and raise awareness about the condition. These organizations have worked closely with local communities, healthcare providers, and traditional birth attendants to ensure a comprehensive approach to prevention, treatment, and rehabilitation (1, 4).
Despite these efforts, challenges persist in the fight against obstetric fistula in Somalia. The healthcare system in the country remains fragile, with limited resources and infrastructure (7). Many women and girls still lack access to skilled birth attendants and emergency obstetric care, making them more vulnerable to obstetric complications. Cultural and social barriers, including early marriage, traditional practices, and limited education, also contribute to the continued prevalence of obstetric fistula (8).
To effectively combat obstetric fistula in Somalia, a multi-faceted approach is needed. First and foremost, there is a critical need to strengthen the healthcare system and improve access to quality maternal healthcare services. This includes training and deploying more skilled birth attendants, establishing functional referral systems, and equipping healthcare facilities with the necessary resources and equipment (9). Community-based education programs that address cultural norms and raise awareness about safe delivery practices can also significantly impact. Furthermore, it is crucial to invest in preventive measures by addressing underlying factors such as poverty, gender inequality, and lack of education. Efforts to empower women and girls, promote reproductive health education, and discourage harmful traditional practices can help prevent obstetric fistula and improve overall maternal health outcomes (4, 10).
International support and collaboration are essential in this endeavor. Continued funding and technical assistance from the international community can strengthen existing programs, scale up successful interventions, and support research to develop innovative solutions. Partnerships between the government, NGOs, healthcare providers, and communities are vital for sustained progress in addressing obstetric fistula (1).
Obstetric fistula continues to be a pervasive problem in Somalia, causing immense suffering for women and girls. However, with concerted efforts, political commitment, and sustained investments in maternal healthcare, it is possible to make significant progress in preventing new cases, providing treatment, and rehabilitating affected individuals. By working together, we can ensure that no woman or girl in Somalia has to endure the devastating consequences of obstetric fistula and that every mother can give birth safely and with dignity.
References
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1.
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Mohamed AA, Ilesanmi AO, Dairo MD. The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia. Obstet Gynecol Int. 2018;2018:5250843. [PubMed ID: 30363732]. [PubMed Central ID: PMC6180917]. https://doi.org/10.1155/2018/5250843.
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Nduka IR, Ali N, Kabasinguzi I, Abdy D. The psycho-social impact of obstetric fistula and available support for women residing in Nigeria: A systematic review. BMC Womens Health. 2023;23(1):87. [PubMed ID: 36841757]. [PubMed Central ID: PMC9960620]. https://doi.org/10.1186/s12905-023-02220-7.
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UNFPA. UNFPA in Somalia From Relief to Development. 2008. Available from: https://somalia.unfpa.org/en/publications/unfpa-somalia-relief-development-0.
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Gele AA, Salad AM, Jimale LH, Kour P, Austveg B, Kumar B. Relying on Visiting Foreign Doctors for Fistula Repair: The Profile of Women Attending Fistula Repair Surgery in Somalia. Obstet Gynecol Int. 2017;2017:6069124. [PubMed ID: 28761443]. [PubMed Central ID: PMC5518510]. https://doi.org/10.1155/2017/6069124.
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UNFPA. Daynille: A hope for fistula patients in Somalia. 2023. Available from: https://somalia.unfpa.org/en/news/daynille-hope-fistula-patients-somalia.
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Qayad MG. Health Care Services in Transitional Somalia: Challenges and Recommendations," Bildhaan. An International Journal of Somali Studies. 2008;7(10).
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Aden JA, Ahmed HJ, Ostergren PO. Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach. Glob Health Action. 2019;12(1):1672314. [PubMed ID: 31599213]. [PubMed Central ID: PMC6792038]. https://doi.org/10.1080/16549716.2019.1672314.
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Ganle JK, Fitzpatrick R, Otupiri E, Parker M. Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana. Int J Health Plann Manage. 2016;31(4):e235-53. [PubMed ID: 25824650]. [PubMed Central ID: PMC7614389]. https://doi.org/10.1002/hpm.2291.
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Nolsoe CP. Campaign to End Fistula with special focus on Ethiopia - A walk to beautiful Is there a role for ultrasound? Australas J Ultrasound Med. 2013;16(2):45-55. [PubMed ID: 28191174]. [PubMed Central ID: PMC5029988]. https://doi.org/10.1002/j.2205-0140.2013.tb00165.x.