Uganda : Rachael Wotali, was just a teenager, married at 17, when she nearly died in childbirth.

It was the year 2015 in eastern Uganda’s Iganga District. Wotali, as a young bride, may have been biologically unprepared for motherhood.

Her labor was extended and blocked, which may have been fatal. Her access to emergency treatment was also critically hampered. She recalls her mother yelling with the health care provider over their extended wait for help.

Unfortunately, the baby died at birth, leaving Wotali with an obstetric fistula, a hole in the birth canal that rendered her incontinent and exposed to a variety of other medical issues, including infections.

“I never enjoyed being a woman in marriage since I had this condition,” she later recalled. “It was tough to live.”

Today, the 23rd April 2022 is International Day to Put an End to Obstetric Fistulas. Fistulas are one of the most dangerous and devastating delivery injuries, and they are virtually totally avoidable. Access to competent maternal health care, particularly Caesarean sections to treat obstructed labor, can save both women’s and their kids’ lives and health.

Although the prevalence of obstetric fistula in Uganda stands at two percent, a 2016 study by the Ministry of Health estimates 200,000 women are living with fistula, and 1,900 new cases occur each year.

Yet more than two million women in the developing world are estimated to be living with this condition. Its persistence is a sign that health and protection systems are failing women and girls.

Wotali lived with an obstetric fistula for six years. In that time, she had a son and a daughter. But, like many fistula survivors, she was isolated, enduring ridicule if she left home. She was unable to do community work, attend funerals or visit church, she told Reproductive Health Uganda (RHU), while receiving family planning.

Nothing appeared to work towards improving the situation. “Traditional herbalists tried everything, and we had been told to do lots of things but the condition was never healed,” she recalled. “When you are in that situation, you try almost everything.”

But one day, one year ago, her sister was chatting with community members at a nearby borehole. Someone mentioned that a woman in the district had received treatment for chronic urinary incontinence. It turned out a fistula repair camp was taking place at Iganga district hospital.

She rushed to tell her mother.

Over 25 women received treatment during the government – private partnership supported event, including Wotali.

“I am now dry. I have no problem,” Wotali said. “This is how a woman should be.”

Many of the women, like her, have endured the condition a long time. One Alowo, lived with fistula for 28 years in Mayuge district but was also treated.

We all need to take action against obstetric fistula. It is estimated that two per cent of women in the country have experienced an obstetric fistula, according to a 2016 survey.

Since her treatment, Wotali has become an advocate for fistula survivors, helping multiple women receive repairs.

She says she still thinks back to the fateful day that she learned there was hope and help for women with obstetric fistula.

“That morning when my sister went to draw water saved my life,” she said.

Aldon Walukamba G, the author, is the RHU Media Advocacy and Documentation Coordinator.