Efforts to reduce cases of obstetric fistula in Mauritania have been slowed by local customs and beliefs.
“Fistula is seen as a punishment,” said Jacques Milliez, a gynaecologist who travels to Mauritania twice a year as part of a treatment programme. “Tradition dictates that a woman who experiences problems in childbirth is suspected of all manner of wrongdoing, such as adultery.”

The causes of fistula are also tied to tradition, with girls marrying and becoming pregnant at a young age, said Thierno Ousmane Coulibaly, the UN Population Fund’s (UNFPA) head of reproductive health in Mauritania. “These girls do not have a sufficiently developed pelvis to give birth.” He added, “It is difficult to fight these socio-cultural practices.”

With just 60 women treated in three years as part of a programme run by the government and the French NGO Equilibres et Populations, local health experts say they have a long way to go to increase awareness about how to prevent and treat the condition.

Obstetric fistula is a tear that develops when blood to the vagina, bladder or rectum is cut off during prolonged or obstructed labour. The tissue dies and a hole forms through which urine and faeces pass uncontrollably.

It is not known how many women in Mauritania suffer from fistula. The UNFPA says worldwide two million women have the condition.

“Operating on 20 women per year is just not enough,” said Mimi Mint Moulaye Cherif, former midwife and head of the national programme on reproductive health. “Our education and awareness efforts are not adequate.”

Physicians from Equilibres et Populations agree that more sustained efforts are needed. “We come only twice a year,” said urologist Ludovic Falandry. “It’s better than nothing but far from enough. What is needed are permanent health teams capable of performing these operations in each regional capital.”

Under the programme, French surgeons travel to Mauritania for short periods to treat women and provide medical equipment and training. Prior to their arrival, civil society members and government health staff go to villages to inform women they have the possibility of being treated.

Yet many women still do not come forward due to the shame associated with the condition.

UNFPA provides US$250,000 annually to help combat fistula in Mauritania. The funds go towards prevention, psychological support and helping sufferers reintegrate into society, Coulibaly said.