Kwamboka W. was still in primary school when she had sex with her first boyfriend. She had no information about contraception and didn’t use any protection. Three months later, she was shocked to learn that she was pregnant.
She was even more shocked when later, after labouring for close to three days and delivering a stillborn baby, she discovered she could not control the flow of her urine and stool.
Kwamboka was only one of the more than 50 women and girls I interviewed in Kenya who suffered obstetric fistula, an entirely preventable and treatable childbirth injury that leaves women with urinary and/or faecal incontinence. It is caused by prolonged, obstructed labour without access to medical care.
I was profoundly moved to meet these women and girls, most from poor, rural backgrounds, who had suffered severe physical and social consequences because of this largely preventable illness.
Mourning the stillbirth of their babies, ashamed of the fetid odour they produced, having lost a chance at education, being confined to their homes, they were left feeling hopeless, depressed and suicidal.
These women were also often shunned and abused by their families and communities or chased away by their husbands.
But most of them endured this suffering without knowing that fistula is treatable. Those who did know about it did not know where to seek treatment, or lacked the money for surgery that could have helped restore their lives, health and dignity.
Kenya has made important progress in preventing and treating obstetric fistula. There have been efforts to educate women and communities about the availability of treatment, training of surgeons to do fistula repairs, equipping hospitals to handle these repairs, and establishing guidelines on fistula services.
Through what are known as “fistula camps,” many women have undergone successful fistula repair.
But major gaps remain.
As the world marks the first-ever International Day to End Obstetric Fistula today, Kenya can, and should, focus more attention on these shortcomings.
To improve access to fistula surgery for some 300,000 women and treat the estimated 3,000 new cases that occur each year, Kenya needs to train more surgeons, train health workers in fistula management, and properly equip hospitals to handle the operations.
The government should also consider subsidising fistula repairs, and providing free surgery for poor patients.
Indeed, Kenya needs to address persistent health system shortcomings that undermine, not only effective response to fistula, but maternal healthcare overall.
One such area is inability to pay the user-fees for maternity services. Many of the women I interviewed who suffered from obstetric fistula complained that they were unable to access quality care because they did not have money for medical fees at government health facilities.
They will be happy to learn that President Uhuru Kenyatta has committed his administration to providing free maternity care.
To ensure this policy is applied, the government should address problems that exist around waivers and exemptions, such as lack of awareness of the current policy among patients and some health providers, withholding of information about waivers when requested by patients, and issues around the State payments to the health facilities for services rendered.
