Gynecologists have raised concerns that reliance on traditional birth attendants (TBAs) is significantly contributing to the high incidence of obstetric fistula in the Busoga region.
Obstetric fistula is an abnormal opening between a woman’s genital tract and her urinary tract or rectum, typically caused by prolonged, obstructed labor. This condition often leaves women leaking urine, feces, or both.
While Uganda’s national statistics estimate the prevalence of obstetric fistula at 1.5%, Busoga reportedly has a higher rate of 2.8%.
Speaking at a UNFPA-sponsored fistula camp at Jinja Regional Referral Hospital, experts highlighted that cases in Busoga are rising because many expectant mothers prefer the services of TBAs during labor. These birth attendants often lack the expertise to detect minor tears in the vaginal or rectal areas, which can lead to fistula.
Angela Namala, a consultant gynecologist, emphasized that TBAs lack the knowledge to properly manage labor and delivery, leading to severe birth injuries that are hard to detect. She pointed out that most TBAs refer mothers to health facilities only after days of prolonged labor, leaving little room to prevent severe injuries.
Namala also noted that many mothers in Busoga have between 10-12 deliveries under unprofessional care, increasing their risk of birth injuries that could be prevented with proper antenatal care.
Joseph Woira, head of the obstetrics and gynecology department at Jinja Regional Referral Hospital, stated that many mothers exhibit poor health-seeking behaviors. They are often reluctant to seek expert care after delivering with TBAs or at home. Without expert advice, detecting and managing fistula in its early stages is challenging.
Woira added that some victims attribute fistula to witchcraft and, in self-denial, avoid medical treatment. The demeaning nature of the condition lowers victims’ self-esteem, causing them to shy away from confiding in health workers.
Woira also pointed out that, despite the presence of government-manned health facilities in most sub-counties, many victims lack the transport fees, as low as 1,000 shillings, needed to reach these facilities for safe delivery or fistula management.
Jinja Regional Referral Hospital’s Deputy Director, Afiz Kibuuka, revealed that they are collaborating with UNFPA and other partners to conduct six fistula camps this year. These camps aim to handle 180 fistula surgeries at Jinja Hospital and Namayingo-based Buyinja Health Center IV over six months.
Kibuuka encouraged all victims to attend their weekly clinics for screening, as Jinja Hospital has a fully constituted team of gynecologists ready to manage fistula cases across the sub-region.