• Irungu Houghton

Post curfew, can we create a fistula free nation?


By Irũngũ Houghton and Dr. Elizabeth Ominde-Ogaja


While partygoers and the entertainment industry celebrated the end of the curfew loudest, the announcement also lifted considerable challenges faced by women, children, and their right to health. Now behind us, what are the new opportunities for expanding reproductive health access and safety for women and children during childbirth?


Seeking maternity and emergency-care services was an extreme sport for many women particularly in the first year of the pandemic curfew. Fearing the police or without transport, women opted to deliver their babies in dimly lit homes risking a ruptured uterus or death. For those that made it to health facilities safely, navigating the COVID-19 virus and attracting strained health-workers and services was another peril. For these women and children there could not have been much to celebrate in the tenth anniversary of the constitution last year.


Chapter 43 states that all human beings have the right to the highest attainable standard of health. Prolonged, obstructed labour directly threatens the sexual, reproductive, and maternal rights of pregnant mothers as well as the rights of new-born adolescents. Without emergency medical care such as a caesarean section surgery, it can lead to obstetric fistula. Health Ministry reports that Kenya has 1,000 new fistula cases every year.


An advisory, let us create fistula vividly. Imagine an excruciating pain when relieving yourself or being unable to stop blood or pus oozing from your anus or bladder after going to do the most natural thing in a woman’s life, giving birth. Imagine years of infection and ostracization puncturing your self-esteem, damaging your nerves and kidney. Fistula attacks physical, sexual, and mental health of women simultaneously.


While fistula is one danger of maternal mortality and morbidity, the broader problem stems for gender poverty and inequality, illiteracy, child marriage and adolescent pregnancy. While fistula eradication strategies have improved over the last decade, the World Health organisation still records as many as 100,000 new cases of fistula annually across the world. The United States have largely controlled fistula. While New York closed its fistula hospital in 1895, Ethiopia still has one. Many women in Africa are left unaddressed for decades.


Two years ago, the Health Ministry launched a National Framework on Fistula Management. Squeezed between indebtedness and the pandemic, implementation has been modest but increasingly corrective surgeries are now available from government, non-governmental and multi-lateral providers for women who need them.


Preventing and treating fistula requires drastically reducing all obstacles that impede women’s access to quick, quality, and compassionate health care. Reproductive health rights analysts have noted that Kenya still only has the capacity to repair 1 in 2 of the cases and the costs can range from KSH 20,000 to 200,000 for a single surgical repair.


With universal vaccination gains and reduced infection rates, it is time for us to all address maternal healthcare and the dangers of obstetric fistula again. As always, we must turn to our health-workers and particularly our mid-wives. Stories of their courage in the face of the danger of COVID-19 are yet to be told well.


As the nation refocuses itself, county governments and the health ministry must invest in our facilities and train midwives and other healthcare workers to provide maternal and emergency healthcare services.


Why is it so difficult for women to secure high-quality care? Could we bring the digitisation gains we have seen in other spaces to this challenge? Smart phone USSD codes and applications have revolutionised the way we report corruption and rights violations or the way we order food deliveries and taxis. Could a partnership between the Council of Governors, NGOs and telephone service providers create a USSD based national helpline for families in need? This angel voices facility would provide an opportunity for self-expression, connection, and love, all at the same time. Just perhaps, this could be another way we could create fistula free families and a fistula free nation.

This opinion was also published in the Saturday Standard, 7 November 2021. Irũngũ Houghton is Amnesty International Kenya Executive Director and Dr. Elizabeth Ominde-Ogaja is a pharmacist and former Government of Kisumu Health County minister. We write in our personal capacities. Email: Irungu.houghton@amnesty.or.ke and emaoogaja@gmail.com