For More Than a Thousand Women in Mali, Dignity Again

The birth of a child should be a joyous occasion. But for women who suffer from obstetric fistula, this is often not the case. With your help, IntraHealth International can help restore dignity to women with fistula in Mali. Consider making a donation today.


Kadiatou knew she needed to get to a health center right away. Her contractions were now extremely painful and coming faster. She asked her brother-in-law—the only other family member at home—to take her. He refused. It was raining, he said.  

Kadiatou tried reaching her husband several times. After a number of missed calls, her husband finally picked up and learned she was in labor. He came home and rushed her to the nearest health facility three kilometers away.

The midwife on duty immediately noticed something was wrong. Instead of being in the desired head-down position, Kadiatou’s baby was presenting arm-first. After a long and difficult labor, the midwife helped Kadiatou deliver her little girl, her third child. Miraculously, the baby survived and only suffered a broken arm.

But a few days later, Kadiatou was unable to control her bladder or bowels. Ashamed and worried that friends and neighbors would find out, she and her husband kept silent and did their best to hide her symptoms.

What Is obstetric fistula?

Like Kadiatou, up to 100,000 women around the world develop an obstetric fistula each year. A consequence of prolonged or obstructed labor, obstetric fistula is a hole that forms between the vagina and the bladder and/or rectum. It happens when a baby’s head or other body part presses too long against the soft tissue in the mother’s pelvis and cuts off the blood flow. Within three to ten days, the tissue may die and create an opening. The mother will then suffer chronic urinary and/or fecal incontinence.

Kadiatou’s baby girl was fortunate. In most cases, the baby dies in the birth canal. For the mother, fistula can lead to infection, kidney disorders, severe nerve damage, paralysis, and even death if left untreated. Women with fistula are often abandoned by their families and shunned by their communities.

Most women with obstetric fistula live in poverty and in cultures where a woman’s status depends on her marriage and ability to bear children. More than two million women in Asia and sub-Saharan Africa suffer from untreated obstetric fistula. In Mali, where Kadiatou lives, a combination of high fertility, low use of modern contraceptive methods, early marriage resulting in adolescent pregnancy, and low rates of facility births puts up to 2,400 women at risk of fistula each year.

Skilled health workers with proper training can help prevent obstetric fistula by recognizing signs of obstructed labor and having plans in place for handling or transporting women when emergencies arise. Caesarean sections, when necessary, can prevent obstetric fistula and help save the lives of mothers and their newborns.

Obstetric fistula is treatable in most cases with a surgery to repair the hole, but the cost of surgical repair, not enough qualified fistula repair surgeons, and long distances to hospitals that perform repair surgeries have made it difficult for women living with fistula in Mali to get the care they need.

Greater care for women in Mali

IntraHealth International is working to improve access to fistula care in Mali. In the past, fistula repair surgeries were only routinely available in the capital city of Bamako and only one surgeon knew how to treat complicated cases. During the former USAID-funded Fistula Care Project, IntraHealth trained 13 surgeons to perform fistula repairs at treatment sites in three regions and provided 460 women with fistula repair surgeries.

Now, through a new USAID-funded project—Capacity-Building for Fistula Treatment and Prevention in Mali, or Fistula Mali for short—IntraHealth is making high-quality fistula care even more available and building health workers’ capacity to prevent, diagnose, and treat the devastating condition.

Over the next five years, Fistula Mali will train at least 15 more surgeons to perform repairs and provide 1,155 women like Kadiatou with fistula repair surgeries in the five regions of Gao, Kayes, Sikasso, Koulikoro, and Bamako. The project will conduct fistula campaigns in each region, and prepare targeted health facilities to offer services on a routine basis.

The project will also provide necessary medical equipment and raise awareness about obstetric fistula and repair campaigns through community education and radio broadcasts.

“We cannot ignore the fact that even today, in our own country, too often giving life is associated with death,” said Dr. Cheick Touré, country director for IntraHealth in Mali, at a July ceremony to launch the project. “The eradication of fistula requires preventive measures, increased access to emergency obstetric care, and action to support the number of existing cases.” So far 47 women have received fistula surgery during the project’s first two repair campaigns in Kayes in Sikasso.

Dignity again

On July 1, 2014—almost one year after delivering her daughter—Kadiatou had a surgery that successfully closed her fistula.

After living with fistula for months, Kadiatou sought treatment from her local health center. Her provider remembered hearing radio broadcasts disseminated on the local Sikasso radio station by IAMANEH (a local partner on the Fistula Mali project) about a fistula repair campaign at the Sikasso Regional Hospital.

After healing, Kadiatou and her husband were determined to fight obstetric fistula in their community. They shared their story in front of regional and national authorities during the launch ceremony for the Fistula Mali project.

“I would like to take the opportunity to express all of my gratitude to the USAID project that supported the total cost of my treatment,” said Kadiatou. “I thank God that I have my dignity again.”


IntraHealth is addressing fistula in Mali through the USAID-funded Capacity-Building for Fistula Treatment and Prevention in Mali project as well as through our Clinton Global Initiative Commitment. Louise Winstanly, Chair of IntraHealth’s Board of Directors, and IntraHealth’s Clinton Global Initiative partners are committed to helping more Malian women live with greater dignity, health, and wellbeing by addressing the needs of those who suffer from obstetric fistula. Through our Clinton Global Initiative commitment, Winstanly, IntraHealth, and our partners will build on the Fistula Mali project to expand fistula care and treatment in Mali, improve collection of data about fistula’s many effects, develop a telephone support network and call-in center through which women suffering from fistula can connect with peers, and better prepare Mali’s health workforce to provide holistic fistula care.


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