Healing the hidden wounds of childbirth – UN News

Report on Obstetric Fistula in Somalia and its Relation to Sustainable Development Goals

Introduction: A Public Health Crisis Impeding SDG Achievement

Obstetric fistula, a severe medical condition resulting from prolonged, obstructed labor, presents a significant barrier to achieving key Sustainable Development Goals (SDGs) in Somalia. This condition, a hole in the birth canal, leads to chronic incontinence, social isolation, and severe psychological distress for affected women. The prevalence of obstetric fistula directly undermines progress on several SDGs, most notably:

• SDG 3: Good Health and Well-being: The condition is a direct consequence of failures in the healthcare system to provide adequate maternal care.
• SDG 5: Gender Equality: As a condition that exclusively affects women, it perpetuates gender-based health disparities and social disempowerment.
• SDG 10: Reduced Inequalities: It disproportionately affects women in poor, rural, and crisis-affected regions, highlighting stark inequalities in healthcare access.

Barriers to Maternal Health and SDG 3 in Somalia

Inadequate Access to Skilled Healthcare Services

Limited access to essential maternal health services is the primary driver of obstetric fistula in Somalia, directly contravening the objectives of SDG 3, particularly Target 3.1 (reduce global maternal mortality) and Target 3.7 (ensure universal access to sexual and reproductive health-care services). Key statistics highlight the scale of the challenge:

• An estimated 60% of births in Somalia occur without the presence of a skilled medical professional.
• According to the United Nations Population Fund (UNFPA), approximately 171,000 pregnant women in the region face significant difficulties in accessing life-saving maternal healthcare.

Impact of Humanitarian Crises and Economic Hardship

The ongoing humanitarian crisis in Somalia exacerbates the risks associated with pregnancy and childbirth. Critically high levels of malnutrition among pregnant and breastfeeding women increase the likelihood of complications. Furthermore, economic barriers prevent access to treatment, directly impacting SDG 1 (No Poverty). The reported cost of a single surgical repair, approximately $800, is prohibitive for most women in affected rural communities, reinforcing a cycle of poverty and poor health.

Collaborative Interventions Advancing the Global Goals

The Power of Partnerships for the Goals (SDG 17)

In response to this crisis, a multi-stakeholder partnership has been formed to provide free, life-changing treatment, demonstrating the effectiveness of SDG 17 (Partnerships for the Goals). A fistula campaign at Dayniile Hospital in Mogadishu is a result of the collective efforts of:

1. The Federal Ministry of Health
2. Physicians Across Continents
3. The United Nations Population Fund (UNFPA)
4. The King Salman Humanitarian Aid and Relief Centre (KSrelief)

This collaboration combines community outreach with the provision of free surgical repairs, targeting women from rural areas who are most affected by the inequalities in healthcare access.

Outcomes: Restoring Health, Dignity, and Gender Equality (SDG 3 & SDG 5)

The surgical interventions have had a transformative impact on patients’ lives, contributing directly to the targets of SDG 3 and SDG 5. The program successfully restores physical health and enables women to overcome the profound social stigma associated with the condition. Reports from patients indicate that the surgery has allowed them to:

• End chronic physical suffering and incontinence.
• Break free from years of social isolation and shame.
• Re-engage with their communities and families, including visiting relatives and attending social events.

By restoring their health and dignity, these interventions empower women to participate fully in society, a core objective of SDG 5. Medical professionals express hope that continued awareness and surgical campaigns will lead to the eventual eradication of fistula, marking a significant achievement in global health and gender equality.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being

  The article’s central theme is obstetric fistula, a severe health complication arising from childbirth. It discusses the lack of access to maternal healthcare, the physical and mental suffering of women like Farhiya, and the medical interventions (surgeries) provided to treat the condition. This directly relates to ensuring healthy lives and promoting well-being.

• SDG 5: Gender Equality

  Obstetric fistula is a condition that exclusively affects women and is a stark indicator of gender inequality in access to healthcare. The article highlights how the condition leads to social isolation and shame (“isolated from my community,” “too ashamed to use public transport”), which are social dimensions of gender inequality.

• SDG 2: Zero Hunger

  The article explicitly links the humanitarian crisis in Somalia to health outcomes by stating, “Malnutrition among pregnant and breastfeeding women has reached critical levels, further increasing the risk of pregnancy and birth-related complications.” This connects the issue of food security directly to maternal health.

• SDG 17: Partnerships for the Goals

  The solution presented in the article—the fistula campaign providing free surgeries—is a collaborative effort. It mentions the involvement of the “Federal Ministry of Health, Physicians Across Continents, and UNFPA, and funding from KSrelief, the King Salman Humanitarian Aid and Relief Centre,” showcasing a multi-stakeholder partnership to achieve a common goal.

Specific SDG Targets Identified

• Target 3.1: Reduce global maternal mortality

  While the article focuses on morbidity (fistula) rather than mortality, the root cause is the same: lack of skilled care during childbirth. The article states that in Somalia, “6 out of 10 births occur without a doctor present.” Preventing conditions like obstetric fistula is integral to reducing maternal mortality and severe morbidity.

• Target 3.7: Ensure universal access to sexual and reproductive health-care services

  The article directly addresses this target by highlighting the “limited access to basic and essential maternal health services” as the primary cause of obstetric fistula. The work of UNFPA, the UN’s sexual and reproductive health agency, and the provision of fistula repair surgery are direct actions towards achieving this target.

• Target 3.8: Achieve universal health coverage

  Farhiya’s story illustrates the barrier of financial hardship, as she could not afford the “$800 surgery cost.” The provision of “free fistula repair surgeries” through the campaign is a direct response to the lack of financial risk protection and a step towards universal health coverage for this specific service.

• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights

  This target is closely linked to 3.7 but with an emphasis on rights and equality. The article shows how the lack of access to maternal care disproportionately affects women, leading to a condition that infringes on their right to health and social participation. The social isolation described by both Farhiya and Nince underscores the gendered impact of this healthcare failure.

• Target 2.2: End all forms of malnutrition

  The article makes a direct connection to this target by stating that “Malnutrition among pregnant and breastfeeding women has reached critical levels,” identifying a specific vulnerable group whose nutritional needs are not being met, thereby increasing health risks.

• Target 17.17: Encourage and promote effective public, public-private and civil society partnerships

  The success of the fistula campaign at Dayniile Hospital is attributed to a partnership between the “Federal Ministry of Health, Physicians Across Continents, and UNFPA” with funding from “KSrelief.” This is a clear example of the multi-stakeholder collaboration that this target aims to promote.

Indicators Mentioned or Implied

• Proportion of births attended by skilled health personnel (Indicator 3.1.2)

  The article provides a direct statistic that serves as an indicator: “In Somalia, 6 out of 10 births occur without a doctor present,” implying that only 40% of births are attended by a doctor, which is a proxy for skilled health personnel.

• Number of women struggling to access maternal health care (Implied Indicator for Target 3.7)

  The article cites a UNFPA report stating, “An estimated 171,000 pregnant women are struggling to access life-saving maternal health care.” This figure serves as a direct indicator of the unmet need for reproductive health services.

• Proportion of population with large household expenditures on health (Implied Indicator for Target 3.8)

  Farhiya’s inability to pay the “$800 surgery cost” is an anecdotal but powerful indicator of high out-of-pocket health expenditures that create catastrophic financial barriers to care for individuals.

• Prevalence of malnutrition (Indicator 2.2.2)

  The article provides a qualitative indicator by stating that malnutrition among pregnant and breastfeeding women “has reached critical levels.” This indicates a high prevalence of malnutrition within this specific demographic.

• Existence of multi-stakeholder partnerships (Implied Indicator for Target 17.17)

  The article explicitly names the partners involved in the fistula campaign: the Federal Ministry of Health, Physicians Across Continents, UNFPA, and KSrelief. The description of this collaboration serves as an indicator that such partnerships are being formed and are operational.

SDGs, Targets, and Indicators Analysis

Source: news.un.org