The Economic Community of West African States (ECOWAS) has committed US$245,000 to support surgeries and reintegration for obstetric fistula--a childbirth injury that creates a hole between a woman's vagina and or rectum.
Benedict Roberts, head of the ECOWAS National Office in Liberia, said women experiencing urine and stool leakage due to obstetric fistula will be identified, treated, and receive livelihood training such as tailoring, pastry making, cosmetology, and soap-making that prepares them for reintegration back into their communities.
"When they finish, we give them a small financial package along with the skills they learn to start as their own empowerment," he said.
Obstetric fistula is a global health issue, with poorer countries being mostly affected. According to the United Nations, an estimated half a million women and girls are living with the condition, with thousands of new cases occurring each year. Most of these are in Asia and Sub-Saharan Africa.
Victims face severe stigma, neglect, and abandonment from their families and communities, leading to trauma and significant psychological impacts on their mental and social well-being. The constant leakage of urine or feces results in severe infections and chronic pain. The malodor associated with fistula makes it extremely difficult for these women to work or participate in social activities, further exacerbating their poverty and social isolation.
In Liberia, the leading risk factors are common, including teenage pregnancy, lack of proper obstetric care, low-skilled birth attendants, and rape. Underdevelopment, rebuilding from the 14-year conflict, and the Ebola crisis have created a critical gap in the country's healthcare system, according to the World Health Organization (WHO).
The fistula treatment and rehabilitation center at Phebe Hospital in Suakoko, Bong County, which was supported with aUS$3.5 million grant from Zonta International through UNFPA, is currently closed due to a lack of funding. Once a beacon for women suffering from obstetric fistula, women were allowed to stay in the dorm and trained in basic skills until full recovery.
Ruth Walker, Ministry of Health (MOH), Fistula Coordinator, said since the UNFPA support halted in 2018, there has been no fistula care in Liberia, and the government is patiently waiting for ECOWAS to start the project.
"So for now we are not doing anything until ECOWAS can start," Walker adds.
Finance is not the only hurdle to fistula care in Liberia--data is another issue. The Health Management Information System (HMIS) at the Ministry of Health has no record of fistula indicators, surgeries conducted, or the victims, says Walker.
However, she said a technical working group was established with the support of UNFPA to create the fistula element in the HMIS, which will serve as fistula indicators.
In an email, Calixte Hessou, UNFPA Programme Specialist, said the indicators were from the UNFPA metadata on maternal health, adding that UNFPA is also supporting the training of physicians as urogynecologists with an emphasis on obstetric fistula.
While the Ministry of Health is awaiting the commencement of the ECOWAS project, Dignity Liberia, an NGO dedicated to restoring hope to women with fistula and their communities through education, healing, and prevention, has constructed a maternal waiting home for 'at-risk pregnant women' in Goyah's Town, Todee District, rural Montserrado County.
Kathi Gutierrez, President at Dignity: Liberia, said the patient could be a woman who previously had a fistula. It can be a woman who is having her first child and is too young to have a baby. It can be someone who has developed gestational diabetes and high blood pressure.
"If you are pregnant and having a normal pregnancy, you would still be welcome to stay at home, but we are trying to identify the women who are high-risk and would not do well in a village setting," Gutierrez said. "However, she noted that only women who register as regular patients, attend at least three prenatal visits to monitor their pregnancy, and closely detect risk factors will be eligible to stay at home. Each time they visit the clinic, they will be required to bring a cup of rice, which will be used to prepare meals for them during their stay at home after the 28th week of pregnancy.
"If a pregnant woman in labor shows up at the home and is not one of our patients, we will not receive her," Gutierrez said. "She will have to go to the hospital. We can call an ambulance for her, but she will be responsible for paying."
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"According to what is necessary, there will be certain tests that they will need to pay for. Also, we will collect $20 before delivery to pay for their delivery."
The clinic, according to Gutierrez, will not do deliveries now. However, patients will be transferred to CH Rennie Hospital in Kakata, Margibi County, for delivery. Deliveries will be done when the next phase of the clinic is completed. "We will have resident doctors on call who will be able to handle C-sections and will start performing our own fistula repair surgery! That is when we will be Liberia's only dedicated fistula hospital."
Obstetric fistula and other reproductive health conditions are mentioned in the draft revised Public Health Law that is before the Liberian Senate. If passed, the Ministry of Health will adopt regulations to ensure access to quality and acceptable sexual and reproductive health and family planning services, information, and education.
