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Story from the Front Lines: Grassroots vs. Treetops

Communities Respond: Women’s Health First!

Early marriage and childbirth are the norm for girls in rural Guinea, and Cire Kante was no exception. Married at age 12, she became pregnant soon after. She spent a week in labor, with assistance from only her mother and a few elder village women. When her husband finally took her to the nearest health center in an old truck, 30 miles away and on roads muddied from heavy rains, it was too late. Cire had a stillbirth and returned home a few days later to find she was incontinent—the telltale sign of fistula.

After treatments from traditional healers failed, her family began to turn on her. “First, I was rejected by my mother-in-law, then little by little by the rest of my husband’s family, and then by my husband himself,” said Cire. She also was not allowed to attend religious ceremonies or community celebrations. “You cannot imagine how painful it is to work alone, eat alone, and sleep alone. The isolation was more painful and destructive than my physical handicap.”

That all began to change in June 2008, when Cire met a woman whose own fistula had been surgically repaired. Cire sought treatment for herself, and before long she underwent a successful surgery at the Jean Paul II Hospital in Conakry, the capital. Slowly—after 11 years—she is getting used to being with people again.

In countries like Guinea, fistula is all too common. In many ways, it represents the challenges of improving maternal health in poor communities, where most women deliver at home, without skilled birth attendants, and many suffer long labors. Emergency obstetric care, including cesarean delivery, rarely is available and often comes too late.

Preventing fistula, a vital part of EngenderHealth’s growing program, means working closely with local leaders to raise community awareness. In Guinea, EngenderHealth’s Innovations Fund (which provides seed money for new and promising programs) is supporting Safe Motherhood Village Committees—groups of volunteers who facilitate care for pregnant women and those living with fistula. The committees identify pregnant women and work with their families to help them get antenatal care and recognize complications and emergencies. They refer women who have obstetric emergencies—and those already living with fistula, such as Cire—to hospitals for treatment.

Through home visits, community workshops at places like local markets, and religious sermons, village committees also help men see the value in supporting their wives and accompanying them to health care facilities. And they don’t shy away from tough subjects, like the consequences of early marriage and violence against women and girls. “These committees address the root causes of fistula: lack of awareness, limited access to health care, and inattention to the welfare of women and girls,” said Moustapha Diallo, EngenderHealth’s program manager in Guinea. “But this outreach isn’t just about fistula. Everything the committees do is helping to save women’s lives,” he added.

At the same time, EngenderHealth is training surgeons to perform fistula repair, increasing doctors’ capacity to offer high-quality obstetric care, and coordinating rehabilitation for women who have had successful surgery, making it possible for them to start new lives.

Success is already evident. In Guinea alone, more than 700 women received surgical repair. Experience there reinforces guiding principles in the approach: Work directly with communities, engage local leaders, and ensure that men are supportive partners. This is not only how EngenderHealth makes motherhood safer, it is also the key to bringing change that lasts—for individuals and communities alike.