Expert appeals to FG, states to upscale emergency obstetric care

By Oluwafunke Ishola

A Professor of Obstetrics and Gynaecology, Oluwarotimi Akinola, has appealed to the federal and state governments to upscale emergency obstetric care toward eliminating obstetric fistula in the country.

Akinola  said this in an interview with the News Agency of Nigeria (NAN) on Tuesday in Lagos, in commemoration of ‘International Day to End Obstetric Fistula’.

International Day to End Obstetric Fistula is celebrated annually on May 23, with this year’s theme as “End Fistula Now”.

Obstetric fistula is a hole between the birth canal and bladder or rectum, caused by prolonged, obstructed labour without access to timely, high-quality medical treatment.

It leaves women and girls leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty.

According to the United Nations Population Fund (UNFPA), 500,000 women and girls are estimated to be living with fistula globally, with approximately 50,000 new cases every year.

It said that obstetric fistula is  the most devastating of all pregnancy-related disabilities and Nigeria accounts for 40 per cent of fistula cases worldwide.

Akinola, former National President, Society of Gynaecology and Obstetrics of Nigeria (SOGON), said obstetric fistula constitutes a major public health problem in Nigeria and prevalent in the Northern part of the country.

According to him, Nigeria’s target to eliminate obstetric fistula by 2023 is  an illusion without the requisite investments and commitment to obstetric fistula prevention, noting that the country will continue to have incident cases.

Nigeria’s Obstetric Fistula Strategic Plan (2019 to 2023) has a vision of an obstetric fistula free Nigeria with the objectives of promoting 30 per cent reduction in the incidence of obstetric fistula.

It also has a target to reduce the backlog of untreated obstetric fistula cases by 30 per cent and facilitate rehabilitation and re-integration of 30 per cent of needy treated fistula patients within the planned period.

The plan was premised on the need to promote universal access to obstetric fistula prevention, quality treatment and rehabilitative services in line with the global campaign to end obstetric fistula by 2030.

“To achieve that, you must scale up your emergency obstetric care which involves improving ante-natal clinic attendance; improve on the number of women that deliver in health facilities; increase the number of women whose deliveries are supervised by skilled birth attendants.

“The last two Nigerian Demographic Health Surveys (NDHS) haven’t recorded improvements in that regard.

“Delivery by skilled providers remains low at 43 per cent, even though the trend has improved from 39 per cent in 2008 to 43 per cent in 2018.

“Also, only 39 per cent of birth takes place at health facilities. Basically speaking, until we improve, we cannot meet the target.

“Besides, we can’t aim to achieve the set targets without reducing the number of underage pregnancy and teenage marriages.

“These are factors that can  lead to situations where a woman cannot deliver by herself and in the absence of emergency obstetric care where caesarean section can be quickly activated, this mostly leads to complications or obstetric fistula,” he said.

The professor noted that any woman could develop fistula.

”However, adolescent or pre-adolescent girls whose bodies are not fully developed for childbearing are particularly vulnerable.

“This is why ending child marriage can help in the fight to end fistula,” he said.

Akinola noted that every childbirth should be supervised by a skilled birth attendant (SBA), adding that complications could be detected early and appropriate intervention or referrals instituted.

The professor said that fistulas could often be repaired, however, many women and girls with the condition cannot access or afford the reconstructive surgery that will transform their lives and restore their dignity.

Data from UNFPA shows that the average cost of fistula treatment was estimated at 600 dollars, which is  beyond the reach of most women with the condition.

Akinola noted that lack of availability of skilled practitioners and poor health seeking behaviour of those affected with the condition was also a barrier to fistula repair.

He said that the International Federation of Gynaecology and Obstetric (FIGO) was training and enhancing fistula repair among practitioners in Nigeria and Africa to bridge the knowledge gaps.

The professor called for increased awareness on sexual reproductive health issues and strengthening the health care system to provide accessible, affordable, quality maternal health care services.

Akinola noted that implementing this would position the country on the path to meet its target of obstetric fistula prevention as well as elimination and enhance maternal health indices.

(NAN)