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affected in Nigeria alone. The resulting physical and social condition often leads to a lifelong sentence of vulnerability and social ostracism from families or communities and therefore extreme difficulties in leading productive lives.

Obstetric fistulas have virtually been eliminated in industrialized countries, as the condition is preventable through a combination of access to adequate transport services, effective management of child delivery services and empowerment of communities through, among others, promotion of reproductive health at the community level.

The overall development objective of the project is to pilot interventions aimed at reducing the occurrence of obstetric fistulas in Ethiopia by addressing the following:

1. Delays in emergency transport access - In a survey of patients, the Fistula Hospital found that on average, it takes women in labor 11 hours to reach a health care facility capable of addressing their needs and that both access to and the inhibitive cost (due to poverty) of transport were the two most important factors contributing to the occurrence of fistula.. Women in labor can spend several hours travelling on a make-shift stretcher over difficult terrain which can induce other health complications for the mother. Where access to roads is available, delays of several days are often encountered as families try to raise the money necessary to pay for hiring a vehicle to transport the patient. Emergency transport costs are an overwhelming financial burden for families across Africa. Even short distances are subject to this difficulty. For example, in the north of Ethiopia 20km outside of the regional center of Bahr Dar, regular minibus access to the town costs 2 birr, but this rises to 100 birr in case of emergency access by a pregnant mother to a health facility. In more remote areas, emergency access costs can easily rise to thousands of birr for transport of a single patient and accompanying family members. The delays in access to health services caused by the difficulties in raising such sums of money are one of the important contributors to the occurrence of obstetric fistula and subsequently increased vulnerability in the country.

2. Delays in the health care referral system at all levels: Poor training in risk identification at all levels of healthcare provision and lack of appropriate means of communication are two important reasons for the occurrence of fistula. The delays occurs at many stages:

When a woman in labor identifies her risk and begins to consult a Traditional Birth Attendant (TBA);

When a TBA identifies the risk and refers her to a health post;

When a health post further identifies risk and refers to a hospital with surgical obstetric facilities and competence.

3. Poor access to information at the community level regarding reproductive health issues, and the increased risks induced by social practices such as early marriage, overburdening, poor nutrition among girls and traditional practices such as Female Genital Mutilation.

Activities carried out during the mission under the seed fund

Stakeholder Consultations

Consultations with local stakeholders were held in Awassa, Addis Ababa and Bahr Dar.  Previous work carried out by local consultants identified two regions, Amhara and Southern as priority areas for interventions. The rationale was based on a wide range of criteria including:  rates of fistula prevalence, the recent creation of Fistula Hospital Outreach Centers in both regions, and rural transport access issues. The consultations had the objective of discussing and identifying the:

1. range of social, health and transport issues underlying the issue of fistulas

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