A country of 38 million in 2014, Uganda has one of the highest total fertility rates in the world (6.2 lifetime births per woman). Despite progress over the last decade, maternal mortality remains high, at 310 deaths per 100,000 live births, well above the 2015 target of 150 per 100,000 set by the government and the United Nations. Limited access to quality maternal care continues to put Ugandan women at risk of pregnancy-related disabilities, such as obstetric fistula, a vaginal injury usually caused by prolonged labor without timely medical attention. Many women are unaware that obstetric fistula can often be repaired, which would vastly improve their lives.
Since 2004, EngenderHealth has partnered with the Ugandan Ministry of Health in their health centers and hospitals to build awareness of obstetric fistula and to support its prevention, treatment, and repair. From 2004 to 2013, we trained 26 doctors and 761 nurses to perform fistula repair surgery and supported a total of 3,534 surgeries. On the prevention side, EngenderHealth greatly improved the quality of obstetric care and family planning services, both of which can prevent obstetric fistula from occurring.
Our work today continues to focus on strengthening fistula prevention and treatment in Uganda with the Fistula Care Plus project. We are expanding efforts to build community awareness, increasing our emphasis on the integration of family planning services with fistula and maternal health care, and addressing the enormous backlog of women awaiting life-altering fistula repair.
Our family planning work spans decades of support for capacity building in clinical methods of contraception, quality improvement approaches, and integration of family planning with HIV and AIDs prevention and treatment. The Expand Family Planning (ExpandFP) project, funded by The Bill & Melinda Gates Foundation from 2013 to 2017, supported two districts (Masaka and Hoima) to improve access to, quality of, and choice of contraceptive methods. The project worked extensively with seven health facilities in the two districts to build the capacity of service providers in all methods of family planning, including long-acting reversible methods (intrauterine devices [IUDs] and hormonal implants) and permanent methods for women and men. ExpandFP supported the training of more than 400 individual providers, supervisors, and other staff/volunteers (while simultaneously reinforcing trainers’ skills). The project also worked with youth peer educators to provide facility- and community-based youth-friendly health services. Through its support to these facilities, youth activities, and outreach services to an additional 38 more rural facilities and 49 community sites, ExpandFP supported the provision of nearly 45,000 family planning services. At the national level, EngenderHealth supports the Uganda Ministry of Health in program planning to improve access to family planning and update national training manuals.