ECOWAS Commits to Combating Obstetric Fistula in Liberia
The Economic Community of West African States (ECOWAS) has pledged US$245,000 to support surgeries and reintegration programs for women suffering from obstetric fistula—a childbirth-related injury that causes a hole between the vagina and rectum, leading to uncontrollable leakage of urine or stool.
Benedict Roberts, head of the ECOWAS National Office in Liberia, announced that women experiencing these conditions will be identified, treated, and provided with livelihood training in skills such as tailoring, pastry making, cosmetology, and soap-making to aid their reintegration into society.
“When they finish, we give them a small financial package along with the skills they learn to start as their own empowerment,” Roberts said.
Obstetric Fistula: A Global Health Issue
Obstetric fistula is a widespread health issue, particularly in poorer countries. The United Nations estimates that approximately half a million women and girls worldwide live with the condition, with thousands of new cases occurring annually. Most of these cases are concentrated in Asia and sub-Saharan Africa.
Victims of obstetric fistula face severe stigma, neglect, and abandonment by their families and communities, resulting in trauma and psychological distress. The constant leakage of urine or feces often causes infections, chronic pain, and malodor, further isolating these women socially and economically.
Challenges in Liberia
In Liberia, the primary risk factors for obstetric fistula include teenage pregnancy, inadequate obstetric care, unskilled birth attendants, and sexual violence. Decades of underdevelopment, the aftermath of a 14-year civil conflict, and the impact of the Ebola crisis have left significant gaps in the country’s healthcare system, according to the World Health Organization (WHO).
The fistula treatment and rehabilitation center at Phebe Hospital in Suakoko, Bong County, once a lifeline for women suffering from this condition, is now closed due to a lack of funding. The center was initially supported by a US$3.5 million grant from Zonta International through UNFPA, which provided a safe space for women to recover and receive training in basic skills. However, since the cessation of UNFPA’s support in 2018, fistula care in Liberia has been at a standstill.
Ruth Walker, the Fistula Coordinator at Liberia’s Ministry of Health (MOH), expressed the urgency of resuming services. “Since the UNFPA support ended, there has been no fistula care in Liberia, and we are patiently waiting for ECOWAS to start the project,” she said. “So for now, we are not doing anything until ECOWAS can start.”
Data and Training Gaps
Funding is not the only challenge facing fistula care in Liberia. The Health Management Information System (HMIS) at the Ministry of Health currently has no specific records on fistula indicators, surgeries conducted, or affected individuals. However, Walker noted that a technical working group, supported by UNFPA, has been established to include fistula-related elements in the HMIS, which will serve as key indicators for future monitoring.
In addition, UNFPA is supporting the training of physicians as urogynecologists with a focus on obstetric fistula. “The indicators were developed from UNFPA’s metadata on maternal health,” said Calixte Hessou, UNFPA Programme Specialist, in an email.
Community-Based Interventions
While the Ministry of Health awaits the ECOWAS project’s launch, community-driven efforts are filling some of the gaps. Dignity: Liberia, a non-governmental organization dedicated to restoring hope for women with fistula, has constructed a maternal waiting home in Goyah’s Town, Todee District, rural Montserrado County. The home provides care for high-risk pregnant women.
Kathi Gutierrez, President of Dignity: Liberia, explained the criteria for admission to the waiting home. “The patient could be a woman who previously had a fistula. It could be a young woman having her first child or someone with gestational diabetes or high blood pressure,” she said.
Women must register as regular patients, attend at least three prenatal visits to monitor their pregnancies, and bring a cup of rice to each clinic visit, which is used to prepare meals during their stay after the 28th week of pregnancy. However, Gutierrez emphasized that women not registered as patients will not be admitted during labor. “We can call an ambulance for them, but they will be responsible for paying,” she noted.
Currently, deliveries are not conducted at the maternal waiting home. Instead, patients are transferred to CH Rennie Hospital in Kakata, Margibi County. Patients are required to pay $20 before delivery to cover associated costs. However, Dignity: Liberia plans to build an adjoining women’s clinic by 2025, where deliveries, including C-sections, will be handled by on-site resident doctors.
Legislative Progress
Obstetric fistula and other reproductive health conditions are addressed in the draft revised Public Health Law currently before the Liberian Senate. If passed, the Ministry of Health will adopt regulations to ensure access to quality sexual and reproductive health services, including family planning, education, and care for conditions such as fistula.
Obstetric fistula continues to pose a major public health and social challenge in Liberia, fueled by inadequate healthcare infrastructure, financial barriers, and deeply rooted cultural stigmas. The condition not only affects the physical health of women but also their mental well-being and social standing, often leading to isolation and economic hardship. Nevertheless, there are promising initiatives aimed at tackling this issue. ECOWAS’s funding commitment highlights the growing regional support for maternal health, while community-based programs and awareness campaigns work to challenge stigmas and educate communities. Legislative reforms also play a crucial role in creating a supportive framework to prevent and manage obstetric fistula.
To achieve meaningful and lasting progress, sustained collaboration among the government, non-governmental organizations, healthcare professionals, and international partners is essential. Prioritizing investments in maternal healthcare, improving access to skilled birth attendants, expanding surgical repair services, and fostering community engagement will be critical in addressing the root causes and consequences of obstetric fistula. By taking these steps, Liberia has the opportunity not only to restore dignity and hope to women affected by this devastating condition but also to strengthen its broader healthcare system, ultimately advancing the country’s progress toward health equity and social justice.
