A Madagascar, about 50,000 women and girls suffer obstetric fistula and are awaiting surgery. 

The fourth National Campaign for the Elimination of Obstetric Fistula was launched this morning at the Regional Reference Hospital Centre presence of her godmother, Mrs. Voahangy RAJAONARIMAMPIANINA, wife of the President of the Republic of Madagascar. In the presence of governmental and local authorities and representatives of the United Nations system. 

The three-week campaign seeks to provide support for greater national investment in maternal health, more resources for the treatment of fistula, but also to combat the stigma of women suffering from this disease.

The obstetric fistula (or vesico-genital fistula) generally results from prolonged and difficult work, without any obstetric intervention (caesarean section) performed in due time. The fetus then exerts excessive pressure on the internal organs (vagina, bladder, rectum) and damages the tissues of the woman. In most cases the baby dies. The woman suffers from severe incontinence which leads to ulcers, infections and sometimes even death. This disabling disease is often hidden because it affects the most marginalized members of society, namely poor young women living in rural and landlocked areas. 

Worldwide, but especially in developing countries, more than 2 million women and girls suffer from obstetric fistula, a disease that hardly exists anymore in industrialised countries. Each year, between 50,000 and 100,000 new cases are added and only 10,000 women in the world have access to restorative surgery. In Madagascar, more than 50,000 women and girls suffer from obstetric fistula and are waiting for restorative surgery. The results of the Survey on the Monitoring of the Millennium Development Goals (ENSOMD 2012/2013) reveal that 4,000 women suffer from this disabling disease each year and the majority of them are between the ages of 15 and 19. 

"If we are gathered here today, it is to show women who are victims of fistula that they are no longer alone, that they are no longer invisible and that we take into account the severity of this problem, which breaks several thousand lives and families every year," said Mr. Mamadou DICKO, UNFPA Resident Representative in Madagascar. 

Since the first national campaign organized in 2011 by the Ministry of Public Health in partnership with UNFPA, about 1,000 women have some fifteen Malagasy surgeons were trained by international experts. The partnership with the World Food Programme (WFP) makes it possible to provide specific nutritional support to the beneficiaries, as well as a family ration for the household during the 20 days of hospitalisation. This support encourages patients to go to the hospital and contributes to recovery and rapid healing after surgical repair of fistulas. Food for the families of the patients helps to support the household during the absence of the woman of the house. WFP will provide 30 tons of food, including rice, beans and vitamin A-enriched oil. 

Between the 29th of April and the 7th of May 2015, an obstetric fistula repair campaign was held at the Hospital Centre Regional of Sambava. During this campaign, six surgical teams were trained in the management of this disease. Forty women with obstetric fistula have been treated and each learner has benefited from the practical and theoretical supervision of international experts. 

In order to reduce the surgical waiting list for women victims of this disease, Public Health in partnership with the MERCYSHIPs organisation and with the support of UNFPA will take care of 450 women victims of obstetric fistula from the 22 regions of Madagascar. This will be conducted in two phases. The first phase took place in March 2015 when 80 women were operated and the second phase will take place between August 2015 and June 2016. 

In Madagascar, four public hospitals (CHRR Sambava, CHRD Ifanadiana, CHRD Mananjary and CHU JRA in Antananarivo) and four confessionals (EJEDA, VANGAINDRANO, MANAMBARO and the Ampasimanjeva Medical Foundation (FMA)) have the technical capacity to operate obstetric fistula . After their operation, women integrate socio-economic reintegration projects enabling them to become autonomous.