BY

GLOBAL HEALTH POLICY PROFESSOR AUXILIA

CHIDEME-
BRIEFS EXAMPLES MUNODAWAFA
PHD., MSN., RN., ANP
OUTLINE OF A POLICY BRIEFS

1 2 3 4 5 6
Introduction Nature and Persons Affected Risk Factors Economic and Social Recommended Cost-
Magnitude of the Consequences of the effective Action Steps
Problem Problem and the Rationale for
Recommending
Them
THE BRIEFS WILL BE GRADED ON THE BASIS OF

Appropriate use of
Clarity evidence and data, both Ref;
Reasonable conclusions
about the country about
and recommendations of 2010 Jones & Bartlett
which the student is
the student Learning, LLC
writing and comparative
countries
POLICY BRIEF
MATERNAL HEALTH, OBSTETRIC FISTULA IN NIGER
FROM: SECRETARY OF HEALTH, NIGER
TO: MINISTER OF FINANCE, NIGER

Introduction
• Countless women in our beloved country of Niger suffer from a
preventable, treatable affliction known as obstetric fistula.
• It is caused by obstructed labor in the absence of timely
medical intervention, in which a tear develops between the
bladder and/or rectum and the vagina.
• This results in constant leakage of urine and feces, which
isolates a woman from her loved ones and community.
• It affects poor women in isolated areas where deliveries are
usually unassisted and emergency medical intervention is not
available.
INTRODUCTION CONT.

Poverty, lack of medical care, malnutrition, early pregnancy, and low status of women are
all risk factors.

Women with fistulas are unable to live normal lives or find employment.

Education, family planning, later births, and improved medical appreciation of the
problem are all cost-effective ways that could properly address this horrific and
unsettlingly common problem.
Fistulas are caused by obstructed labor without medical NATURE AND
intervention.
MAGNITUDE
If a woman is unable to pass a baby through the birth canal OF THE
easily, she often labors for several days, whereupon the
descending fetus’ head causes a compression between the
PROBLEM:
tissue of the pelvis and the woman’s pelvic bone.
The tissue dies due to lack of blood flow, and a tear develops
between the vagina and the bladder or rectum.

This causes constant leakage of urine or feces that continues

unless it is surgically corrected.
NATURE AND MAGNITUDE OF THE PROBLEM
CONT.

The baby usually dies.

Women affected are
shunned by their husbands Good data on fistulas is
and family members and
become “modern-day
lepers.”
This is compounded by the
Women that encounter this
Due the enormous stigma fact that many women who
problem live impoverished
attached, fistulas are suffer from fistulas never
scarce. existences, uneducated and
underreported. receive any kind of
unaware of their resources.
treatment.
NATURE AND MAGNITUDE OF THE PROBLEM
CONT.

Niger has the highest fertility rate

Research suggests that obstetric
in Sub-Saharan Africa, with a The maternal mortality rate is 920
fistulas in our country are
contraceptive prevalence of only per 100,000 live births.
incredibly common.
4%.

Because we know that fistulas are

results of obstructed labor in the
absence of timely medical
Eighty-five percent of Nigerien
Adding to the prevalence of intervention, we may assume that
women labor and deliver in their
ignored or unattended fistulas is the problem is further
homes, usually without the
the fact that only 30% of women complicated by the fact that only
presence of a trained health
seek antenatal care. 2% of our children are born via
provider.
Cesarean section, the intervention
most typically used to relieve the
pressure of obstructed labor.
AFFECTED POPULATIONS:

Access to healthcare and

Those most affected are
Fistulas devastate the medical intervention are
poor women and girls
lives of countless imperative and many of
who live in rural and
Nigerien women. our women lack the
remote areas.
resources.

Fistulas often occur in

women who are very
young.
AFFECTED POPULATIONS CONT.

Considering how many of our

Only three sites in Niger- This fact is staggering
women suffer from fistulas,
Niamey, Maradi, and Zinder- considering of the numbers of
numbers of health centers and
offer fistula repair and only six our women and girls who cannot
healthcare professionals who
surgeons in have the necessary live normal, productive lives due
have the means to treat them are
training to treat fistulas. to this problem.
bleak.
RISK FACTORS
 

Women and girls who are

Many of the root causes of
One significant risk factor is poor are more likely to live
obstetric fistulas stem from
isolation. far from a source of
poverty.
emergency care.

Many Nigerien women have

They lack the resources of
weaker bodies and lack
family planning, prenatal
Malnutrition is another essential nutrients and health
care, and timely medical
issue. to bring a child to full term
intervention that could easily
and deliver without
prevent and treat fistulas.
complication.
RISK FACTORS CONT.

1 2 3 4 5 6 7

Additionally, The average age It has been Because these Their statures are Obstructed labor It is common for
women who of first marriage reported that 36% women are small and their can last for up to these girls to
suffer from in Niger is of girls aged 15 to having children pelvises are six or seven days. spend days trying
fistulas are often fifteen; however, 19 have either so early, many of underdeveloped, to push doomed
very young. girls marry as been pregnant at them are not causing fistulas. fetuses through
early as nine in least once or had completely their child-like
certain regions. at least one child. physically frames, ending in
mature. heartbreak and
life-devastating
fistulas.
RISK FACTORS CONT.

1 2 3
Another source of the problem is the A major contributor to the fistula Girls are often forced to marry young,
traditions and cultural practices that problem is our sisters’ general lack of providing economic hope for their
many of our people observe, as well empowerment. Women often don’t families in the form of dowries.
as their values. have the luxury of choosing when
they will begin childbearing, hence
the astronomical numbers of young,
underdeveloped girls having children.
SOCIAL AND ECONOMIC CONSEQUENCES

This isolation from

The most obvious consequence
communities, compounded by
of obstetric fistula is social
They are often abandoned by the heartbreaking loss of a
abandonment and neglect.
their husbands, families, and stillborn child that usually
Women with fistulas smell of
friends. accompanies fistula, brings
feces and urine and are unable
remarkable grief and suffering
to lead normal lives.
to our women.

Because many of them don’t

understand their affliction, they
often feel as though they have
been “cursed by God.”
SOCIAL AND ECONOMIC CONSEQUENCES CONT.

Work in food preparation,

Worldwide, fistulas place
severe economic
limitations on women.
Their ability to earn a
for example, is nearly
living is practically
impossible for women with
nonexistent.
fistulas.

In our country, even With no education or job

women who have had their skills, many of them turn
fistulas repaired are often to sex work, frequently in
still refused by their areas where rates of
husbands. HIV/AIDS are high.
PRIORITY ACTION STEPS

01 02 03 04 05 06 07
The key to The key to There is an Illiteracy among It is vitally Education and Deliveries must
assuaging the prevention is indisputable link our women is important that our community based be assisted and
problem of education. between the 91% and the government change will help emergency care
fistulas in our education of budget allotted by invest sufficiently our women must be sought
country is women and our government in the education understand that and realized if it
prevention. maternal health. for education and of our girls. their health is needed.
health has not transcends
been upheld. cultural practices
and that it is
vitally important
that they receive
the care that they
need in time.
PRIORITY ACTION STEPS CONT.

Research shows that,

worldwide, meeting the Women must be
It is imperative that we This could be done
need for family planning encouraged to postpone
increase access to family through legislation on
services would reduce pregnancy until they have
planning. child marriages.
maternal injuries and reached physical maturity.
deaths by 20%.
PRIORITY ACTION STEPS CONT.

The country desperately Provide better

Finally, there is the
needs more healthcare An active role must be transportation between
question of getting
providers and taken in enhancing the medical sites for women
fistula patients the
professionals who are lives of our women. experiencing obstructed
treatment they need.
trained to treat fistulas. labor.
IN Through funding national projects for women with
CONCLUSION fistulas and improving communication with the public
and private healthcare sector and NGO’s, complemented
by education, help may finally get to those who need it
most.
REFERENCES

• “Crisis in Niger: Duke Takes Action for Global Women’s Health.” Duke Medical Alumni Association.
http://medalum.mc.duke.edu/medalum/DMANweb/Spring07/CoverStory.htm Accessed on: February 2, 2018
• “Frequently Asked Questions.” Campaign to End Fistula. United Nations Population Fund.
http://www.endfistula.org/q_a.htm Accessed on: February 2, 2018
• “Obstetric Fistula Needs Assessment Report.” EngenderHealth. 46-49
http://www.engenderhealth.org/pubs/maternal/fistula-assessment.php Accessed on: February 10, 2018
• “The Second Meeting of the Working Group For the Prevention and Treatment of Obstetric Fistula: Addis
Ababa.” 2002. UNFPA. https://www.unfpa.org/upload/lib_pub_file/146_filename_fistula_kgroup02.pdf.
Accessed January 20, 2017