Reproductive health

Over 25000 women and girls die each year More than 500,000 Ethiopian women and girls suffer from disabilities0.3% of all deliveries (8000-9000) develop obstetric fistula

Obstetric Fistula

It is a hole that forms in the vaginal wall communicating with the bladder (Vesico-Vaginal Fistula) or the rectum (Recto-Vaginal Fistula) or both, as a result of obstructed labour, beyond the reach of medical help.

Usual features of fistula patients:-

Young peasant girls Married in their early teens Given heavy tasks in the household Not having an access to any health institution

during labor (long distance, no transportation) Labor prolonged and obstructed (average 3.8 days,

range 1-10) These young women often helped by women of the

village Baby dies in uterus Head collapses and dead baby is expelled

Usual features of fistula patients:-

Few days latter a new horror wakes them up- incontinence

Often whishes they died with the baby, many commit suicide

Soon deserted by their husbands, ostracized by their village friends, excluded from their old social life

They exist without friends, without hope, bearing their sorrow and suffering in silent shame

Patient distribution by region

Amhara 39.7% Oromo 28% Southern 17% Tigray 6.4% Harar 0.6% Benshangul 0.3% Somalia 0.3% Others 4.0% AA 2.0% No information 1.2%

Age profile

<16 5% 16-20 38.4% 21-25 23.6% 26-30 16.5% 31-35 8.1% 36-40 5.8% 41-45 1.3% >45 1.2%

The Addis Ababa Fistula Hospital

The second fistula hospital; Founded in 1974

A free charitable hospital Operated more than 25000 patients Operates 1200-1300 patients/year Trains doctors On the process to establish 5 outreach

centers Six gynecologists

The Addis Ababa Fistula Hospital

12 nurses and more than 40 nurse aids

A village for fistula patients with conduits

Have school and physiotherapy department where they exercise for the crippling injuries

Cause of Fistula

Obstructed laborObstructed transport Reginald Hamlin

PROBLEM AREAS

A- Problems directly related to the three delays:Delay in decision makingDelay in transportation to health institutionDelay of care in health institutionB- Other socio-cultural problems (contributing

factors)

Delay in decision making

-Low status of women (Low involvement of women as decision makers)-Illiteracy-Inhibitory socio-cultural practices-poverty-poor information on health issues (both to men and women

Delay in transportation to health institution

-Distance-Poor roads -Transportation system, not existing-No means of communication -Poor referral system -Poverty

Accessing EMOC was difficult, because:-

Distance 28.2 Economy 13.6 Poor knowledge 9.8 Referral 4.7 Distance and economy 23 Poor knowledge +Economy 11.3 Poor know +distance 2.3

Accessing EMOC was difficult, because:- cont

Dista+ economy+ poor know 5.2 Referral +poor knowledge 0.9 Referral + economy 0.5 Referral +distance 0.5 Total 100

Delay of care in health institutions

-Financial accountability (resources, supplies, etc)-Health staff motivation (lack of commitment, urbanization, etc)-Managerial accountability (Budgets underutilized)-Manpower inadequate- Restrictive laws

Other factors

-Illiteracy -Harmful traditions -Poor access to other reproductive

health care services

Interventions

Access to information Access to EMOC Quality EMOC

Access to information

School enrolment Community education IEC/BC

Access to EMOC

Road Transport Communication (link) Affordability

“Those mothers who failed to access road to EMOC will easily access road to death or disability’’.

Quality EMOC

Capacity building

-training

-equipments and supplies sustainability Affordability/free of charge