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Many of the approaches that prevent obstetric fistula are the same ones that make motherhood safer in general. EngenderHealth has historically helped hospitals and health centers to improve their services. In the context of improving maternal health and strengthening obstetric care, Fistula Care Plus’s facility-based prevention work focuses on:
Family planning allows couples to delay early births, space desired births, and limit family size. Up to one-third of all maternal deaths and injuries could have been prevented if women had access to contraception. Family planning can also help women with a repaired fistula achieve a successful pregnancy, if that is their desire, by helping them delay a future pregnancy until they are fully healed. Women who have experienced repair are generally advised to abstain from sexual relations for a period of time to allow them to heal. In some situations, for some women find it difficult to comply with this recommendation. Other women may need a longer time before they are able to successfully sustain a pregnancy, and family planning methods can help couples determine when is the best time to get pregnant.
The partograph is a low-tech tool for preventing and managing prolonged or obstructed labor, a significant cause of reproductive morbidity and mortality. It is a preprinted one-page form on which observations of the progress of labor and information about maternal and fetal condition are recorded. The partograph is designed to act as an “early warning system,” alerting doctors, midwives, and nurses to the need for action—e.g., referral to a higher level facility, labor augmentation, or cesarean section. Correct and consistent use of the partograph has the potential to reduce obstructed labor and its adverse consequences, including fistula.
If a woman with obstructed labor arrives at a hospital and is believed to be at risk for obstetric fistula, immediate catheterization can help to prevent the fistula from developing. The catheter should remain in place until well after the end of labor.
Timely cesarean section is critical for women with obstructed labor. Doctors performing a cesarean delivery must be competent so that they do not inadvertently create an iatrogenic fistula. Fistula Care Plus works with hospitals to ensure that quality cesarean sections are available from trained health professionals.
Fistula Care Plus partners also work to prevent fistula at the community level. Activities include social mobilization and awareness-raising campaigns, dramas and broadcasts about the importance of antenatal care and assisted delivery, and support for transportation and referrals.