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The impact of USAID cuts on the fight against fistula

The impact of USAID cuts on the fight against fistula

USAID cuts health services in Malawi dependent on aid

The threat to progress on maternal health, which includes fistula, is real

Donors, including UNFPA, support lone fistula clinic

By Charles Pensulo

She could have suffered permanent damage, been incontinent, and even been expelled from her community if she had developed an obstetric fistula after giving birth to her second child.

The 31-year old mother, however, is in front of the hot stove, in Kukawundu, a village near Lilongwe in Malawi, excited to serve the scones that she will be cooking in the tearoom she runs with Damston.

Lloyd, who lost her baby in 2017 during a difficult labor and suffered a fistula (a small hole between a birth canal and the bladder/rectum), was able get reconstructive surgery at the only specialized treatment centre in Malawi.

Lloyd explained that after he recovered from his labor, he discovered a urine leak. Then, they told me that the problem was a fistula. But it could be fixed.

The Bwaila Fistula Care Centre, a 35-bed facility in Lilongwe that offers surgical treatment, rehabilitation programs and community reintegration is supported by UNFPA (the United Nations agency for sexual and reproductive health) and Freedom from Fistula Foundation.

Now, programs for treating fistula as well as other maternal conditions in Malawi and elsewhere are threatened by global aid cuts. This includes President Donald Trump’s decision to eliminate the U.S. Agency for International Development.

UNFPA reported in April that 43 grants totaling $330 million had been affected.

The grant included funds to provide critical maternal health care and protection against violence as well as rape treatment, and other life-saving treatments in over 25 crisis-affected countries and territories.

Natalia Kanem, UNFPA Executive Director, said that the cuts would force women in crisis areas to give birth in unsafe conditions without midwives, medicines or equipment. This could put their lives, and those of their babies, in danger.

According to a report released by the Non-Governmental Regulatory Authority, a government agency that regulates NGOs, in Malawi, which is one of poorest countries and also one of those hardest hit by climate change-related droughts and flooding, aid cuts have impacted critical sectors such as health care, education, and humanitarian assistance.

According to the report, "Many NGOs had to scale back activities, layoff staff, suspend service deliveries, and in some cases shut down entire programmes."

Richard Delate (UNFPA's acting representative for Malawi) described the funding situation in Malawi as "fluid."

He told reporters that "we have seen many donors, with the U.S. Government being the most prominent. There have been large reductions and rough reductions of funding."

He said that governments have been forced to pivot and rethink their response. Initiatives like UNFPA’s Maternal and Newborn Health Fund will be looking to attract new funds.

Delate added, "I don't believe we will be able ever to fill in the gaps left by the U.S. withdrawal."

PROGRESS "SLIDING BACK"

According to the United Nations, obstetric fistula can be caused by prolonged or difficult labour. The majority of the 500,000 women who suffer from this condition live in the Global South. Around 90% of women who suffer from a fistula will also lose their baby.

The smell of urine and feces from untreated fistula can cause women to be shunned. This can cause depression and worsen the poverty.

Reconstructive surgery can be used to repair a fistula, but many women are unaware of the treatment options or do not have the funds to travel to specialist clinics.

UNFPA states that the key to ending fistula is to ensure all women have access both to emergency obstetric and birth attendant care, as well as to family planning.

The global aid cuts are hitting these services hard.

Margaret Moyo is the country director of Freedom from Fistula Foundation. She says that although they would like to expand their clinics, they are now more concerned about survival.

She said, "You don't know how long the donors will stay here... So sustainability is key and government is working toward that."

Aid cuts have also led to a decrease in funds for women to get to the clinic.

Samson Mndolo, Malawi's Secretary of Health, said that the government is evaluating the situation in order to prevent "slipping back" from the progress made.

He said, "We will as a nation prioritize and see how to help fill the gap... because it will help us prevent a lot potential complications downstream." Lloyd, who learned how to open her tea shop at the care center, was trained on skills that would help her become independent when she left. It is important to do this for young women, as teenagers are more susceptible to obstetric fistula.

Delate explained that "young women with fistula face high levels of social stigma because of a variety of factors, such as body odors or the fact they had a teenage pregnancy."

He said that "supporting these women is also a way to restore their dignity and sense of self-worth and I don't believe one can measure this in financial terms."

Lilian James is sewing reusable pads at the Bwaila Center. She learned this skill during her rehabilitation.

James was given a sewing-machine and a solar panel for her rehabilitation. She can now run a small charging business, which allows her to purchase goats and chickens.

She added that her newly discovered self-sufficiency has allowed her to help others.

"I used to be stigmatized, but I'm no longer." "I do volunteer work in both the church and community," she said.

(source: Reuters)