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Campaign for fistula free Bangladesh among girls

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Sk Nazmul Huda and Lauren Bellhouse :
Female genital fistula is a devastating chronic obstetric morbidity. Following labor trauma, women with obstetric fistula experience consistent leaking urine and/or stool through the birth canal. Prolonged obstructed labor is one of the main causes of this condition - where the baby remains impacted in the birth canal for many hours, causing damage to the wall of the vagina and/or rectum through which urine or stool flows uncontrollably.
Recently, surgical trauma has emerged as a rising cause of fistula, particularly in South Asia. Many cases of fistula in Bangladesh are identified after hysterectomy operations or following caesarean section.
Historically, the poorest of the poor in society suffer from obstetric fistula- those who did not have access to adequate maternity care or safe surgery. No matter their social status, fistula seriously affects the quality of life of women. Because of leaking urine or feces, they are often shunned by their communities and even their husbands. In this age of tremendous developmentsin science, technology, and economy fistula is not acceptable in any community. Dr. Sathya Doraiswamy, the Head of Health of UNFPA, Bangladesh rightly said,"Fistula is not only a hole in the female genital tract- but it is a hole in the soul of humanity."
Obstetric fistula disappeared from North America and Europe many decades ago. But still now, in many African and South Asian countries including Bangladesh, fistula is a significant health concern. According to WHO, 1 to 2 million women are living with fistula worldwide. Every year, 50000 to 100000 new cases are added to this burden globally. A survey conducted by EngenderHealth and UNFPA in 2003 reported that approximately 71,000 women are living with fistula-like symptoms in Bangladesh, with approximately 2000 new cases of occurring every year.
The United Nations has called upon its member states to end obstetric fistula within a generation, meaning that every girl child born henceforth must have a fistula free life. Bangladesh is committed to achieve this goal. The Fistula Care Plus Project, a global initiative of EngenderHealth funded by USAID, is working with Bangladesh Government along with UNFPA, Obstetrical and Gynecological Society of Bangladesh, and many other stakeholders for the prevention, treatment, rehabilitation, and reintegration of fistula cases in our country. Since 2007, thousands of women with fistula have received free repair surgerywith the support of the USAID-fundedproject.
In order to truly end fistula in Bangladesh, not only must women with fistula receive treatment, but new cases must be prevented. To aid in this effort, Fistula Care Plus recently launched an activity called "School Girls for Fistula Free Bangladesh." Thousands grade X and IXgirls attending rural schools are participating in the initiative. Enrolled students attenda one-hour session on fistula and are presented with a road map to prevent fistula in their family and community. Students earn points for such accomplishments as learning about fistula, making a pledge for marriage after completing education, referring women for antenatal care, referring for hospital delivery, and identifying and referring any women with fistula for treatment. Whena student earn 100 points, they may submit a report to their nearest community clinic. The Community Health Care Promoter of Community Clinic will endorse their report, and Fistula Care Plus will recognize their achievement as a fistula champion in their community by giving a beautiful certificate.
A teacher at a supported school reported that, "School Girls for Fistula Free Bangladesh infuses a spirit among the students to make their country free from obstetric fistula. This activity is a fusion of entertainment and education." Through this activity, students are linked with Community Clinics and other local institutions for social actions. As a result, a whole community is mobilized to achieve the goal of a fistula free Bangladesh.
Bangladesh had made wonderful progress in maternal and child health in the last few decades. The maternal and child mortality rate reduced significantly, and Bangladesh achieved MDG 4 and 5. Stillmany mothers are dying and experiencing severe morbidities like fistula due to lack of adequate antenatal and maternity care, including access to emergency care during childbirth. At present, only one third of pregnant women receive complete antenatal care and roughly 40 percent deliveries are assisted by a skilled birth attendant. To make our country fistula free, the antenatal care coverage must be increased and all deliveries should be attended by qualified persons.
Universal pregnancy and delivery coverage is a big challenge as the annual birth cohort of Bangladesh is now roughly three million. In schools, we have 1.5 million girls studying at grade IX and X who are full of energy and are willing to make a difference for themselves, their families, and communities. Their willpower must bemet with opportunities, which Fistula Care Plus of EngenderHealth aims to provide inBangladesh. By organizing adolescent girls in rural villages, educating them on social issues, and linking them with local resources like community clinics and radio, Fistula Care Plus hopes to provide a platform for these girls to realize a life free of fistula.
(Dr. Sk Nazmul Huda is a public health project manager in Bangladesh and Ms. Lauren Bellhouse is a public health professional at New York).

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