Doctors in Burkina Faso say fistula is being under-reported, and are launching a new project to offer free surgery to some of the affected women.

According to the government’s statistics, there were just 54 cases of fistula in Burkina Faso in 2007. But Aboubakar Coulibaly, a doctor in the national health system, said “Cases are being under-reported.”

The main causes of fistula are men raping and impregnating very young children, and prolonged obstructed labour, usually because women and child-mothers do not have access to even the most basic health facilities.

The UN Population Fund (UNFPA) says there were 86,140 ‘severe obstetrical complications’ reported in Burkina Faso in 2007, of which 73,000 occurred in rural areas where health coverage is poor.

Fistula, a severe medical condition caused when a hole develops either between the rectum and vagina or between the bladder and vagina, is only found in extremely poor countries which have not invested in proper healthcare systems, education, or protecting women and children.

In Burkina Faso the highest incidence is in the north in the Sahel region.

“Women in the Sahel are most exposed to fistula due to social reasons which stop them from attending health services, and the fact that they marry and get pregnant younger,” said Fatoumata Zampaligre, a director at the ministry of health.

The region accounts for nearly one million of Burkina Faso’s 14 million population.

The government says it has launched a US$4.7 million (euro 3 million) project to prevent and treat obstetrical fistula in this region.

The project covers the four provinces of Soum, Séno, Oudalan and Yagha, and is fully funded by the Duchy of Luxembourg.

It includes fistula repair operations, and a sensitisation campaign directed at community and political leaders and administrative officials advising against marrying and impregnating children, as well as performing cliterodectomies (female genital mutilation/cutting).

According to government statistics, only 26 percent of rural people in Burkina Faso have access to health services, and only 39 percent of women receive modern healthcare when they are giving birth.

Last year, government health facilities repaired just 14 fistulas.

IRIN