Using data from the 2016 Ethiopian Demographic and Health Survey, a recent 2021 study by Woldia University (published 7 July 2021) in Ethiopia has identified obstetric fistula as a devastating obstetric issue in Ethiopia with continued prevalence. The study looked at 7,590 women over five years who had given birth and found that of these women, 32 had experienced fistula. This number is large and directly attributed to women’s circumstances of living rurally and having limited access to nearby health care facilities.
The importance of rural health care
Although 5% of women globally will enter an obstructed labour, women who do not have access to maternal health care and progress in their obstructed labour without medical attention, may experience an obstetric fistula. Despite being a widespread problem in Ethiopia, there are factors that increase a woman’s chances of experiencing a fistula injury. Women living a considerable distance from health clinics were 3.7 times more likely to experience fistula. Additionally, women living in rural areas were 1.5 times more likely to experience fistula. This study confirms the dangers of being distanced from medical care for Ethiopia’s rural women. Fistula is an entirely preventable and also treatable condition. Due to their circumstances, women are tragically left vulnerable to fistula injuries. This is why having increased access to rural health care is so important for remote communities.
Extending a helping hand
The work of Hamlin Fistula Ethiopia extends hope to rural women who are at greater risk of experiencing a fistula injury. With six dedicated Hamlin fistula hospitals strategically placed across Ethiopia, Hamlin is able to offer care to women across different regions, ensuring more women can access life-changing treatment for their fistula injuries. Additionally, Hamlin’s Patient Identification Program, which recommenced in January this year, has a crucial role in identifying women in rural areas who are living with untreated fistula injuries. This innovative outreach program sees Hamlin Patient Identification Officers travel hundreds of kilometres every week, going door-to-door, to locate women in need and connect them to treatment at Hamlin. With an estimated 31,000 women living with fistula injuries in Ethiopia, particularly rural areas, this outreach work is more important than ever. Hamlin Patient Identification Officers also teach local medical officers and community leaders about obstetric fistula and how women can receive help, raising awareness and acceptance at a community level.
The role of Hamlin Midwives
In addition to Hamlin Fistula Ethiopia’s six regional fistula hospitals and outreach program, a large part of ensuring care reaches the most remote areas is via the placement of Hamlin Midwives into rural communities. The Hamlin College of Midwives exists to provide skilled maternal health care in remote, rural parts of Ethiopia. Ethiopia has 12,500 trained midwives for a population of 109 million people. Our Hamlin College of Midwives is steadily increasing the number of midwives across rural Ethiopia through placement of Hamlin Midwifery graduates in Hamlin-supported midwifery clinics.
Women from rural communities are selected to the Hamlin College of Midwives to complete a four-year Bachelor of Science in Midwifery Degree. Upon graduation, they are deployed to their local communities where they are able to provide best-quality maternal health care to women. Nearly 200 Hamlin Midwives have graduated from the college and staff a large number of Hamlin-supported midwifery clinics in rural areas across the country.
Hamlin Midwives and fistula prevention
The presence of Hamlin Midwives in these areas is desperately needed and has proven results for the ability of rural women to deliver their babies safely. Of the 30,000 babies delivered by Hamlin Midwives last year, not one woman experienced an obstetric fistula injury. The recent Woldia University study also concluded that the delay in the decision to seek care when a woman is experiencing an obstructed labour is a contributing factor in the likelihood of an obstetric fistula developing. Therefore, Hamlin Midwives have a hugely important role in recognising when a woman is in an obstructed labour and requires further care. Hamlin Midwives have to make timely decisions about identifying complications and transferring women to nearby hospitals for further medical attention and often a safe caesarean delivery.
Of the 32 women found by the Woldia University study to have experienced an obstetric fistula, 20 of these fistula injuries were developed due to an obstructed and prolonged labour. As obstetric fistula is a preventable childbirth injury, the increasing presence of Hamlin Midwives in remote areas of Ethiopia helps to ensure that a woman’s rural location is not a barrier to accessing quality maternal health care and not a cause for her to end up with a fistula injury.
Towards a safe future for every Ethiopian woman
The recent Woldia study confirmed the position of rural women as being more vulnerable to experiencing an obstetric fistula injury. The team at Hamlin Fistula Ethiopia is committed to Dr Catherine Hamlin’s vision for a midwife in every village of Ethiopia. We believe no woman should have to endure the agony of fistula. The Hamlin team will continue to increase its presence in remote areas of Ethiopia, via Hamlin Midwives and patient identification outreach.
We won’t stop until fistula is eradicated. Forever.
The work of Hamlin Fistula Ethiopia is only possible thanks to the generosity of supporters. If you would like to support Hamlin’s work in rural Ethiopian communities, please consider making a tax-deductible donation here today.
- Woldia University, Ethiopia: Estimating the Prevalence and Risk Factors of Obstetric Fistula in Ethiopia: Results from Demographic and Health Survey.
Written by Anna Norden, intern at Catherine Hamlin Fistula Foundation.