Fistula Care Plus (FC+)
The World Health Organization estimates that between 50,000 to 100,000 women develop obstetric fistula each year. The UN Population Fund’s Campaign to End Obstetric Fistula set a goal to eliminate fistula by 2030 by treating existing cases and preventing new ones.
Fistula Care Plus (FC+) was USAID’s flagship program to address fistula at global and national levels. Building on, enhancing, and expanding on our work in the previous Fistula Care program, FC+ partnered with international, regional, national, and local institutions to strengthen public and private sector fistula prevention and repair services. EngenderHealth worked to strengthen the evidence base to improve fistula care and scale up monitoring, evaluation, and indicators for prevention and treatment.
Through our work, we documented and shared evidence that fistula is increasingly caused by poor obstetric practice during cesarean deliveries and hysterectomy surgeries. The program established and contributed to global guidance, standards, and measurements to guide fistula repair and shared information regarding the benefits of physiotherapy for improving surgical outcomes and the effectiveness of nonsurgical repair techniques for some fistula cases.
EngenderHealth worked to improve community understanding around practices to prevent fistula, to reduce stigma related to fistula, and support reintegration of women and girls with fistula, including those whose fistula is deemed incurable, and those whose fistula is the result of sexual violence. FC+ also worked to reduce transportation, communication, and financial barriers to improve access to preventive care, detection, treatment and reintegration support. In addition, the program strengthened provider, health facility, and health system capacity to provide and sustain high-quality services, including integrated family planning services.
Through FC+, EngenderHealth supported the provision of approximately 15,230 fistula repair surgeries as well as 1,127 nonsurgical fistula repairs. The program trained 123 surgeons in surgical fistula repair, 10,531 health personnel in nonsurgical services, and 3,387 community volunteers and educators in fistula prevention and care. Through approximately 66,000 community and outreach events we reached more than 2 million people and through mass media campaigns we reached more than 57 million. Project-supported facilities provided approximately 1.5 million counseling sessions and contributed to over 1 million couple years of protection. We shared program learning through 37 peer-reviewed journal publications, 42 research reports and technical briefs, 11 webinars, 175 conference presentations, and 84 blog posts. This work has also helped support policy changes that tackle the root causes of fistula, including lack of access to family planning and emergency obstetric care.
This work is being continued through the MOMENTUM Safe Surgery in Family Planning and Obstetrics program. This new program supports the expansion of high-quality fistula care, including addressing barriers to care and treatment created by a lack of knowledge and stigma about the condition; addressing the causes of fistula that result from surgery; and advancing global targets to end fistula by 2030. It also supports increasing access to and quality of surgical services for obstetrics and voluntary FP, including long-acting reversible contraception and permanent methods.