Our beginnings

The idea for Women’s Dignity grew out of the first comprehensive fistula initiative in Tanzania which began in 1995 at Bugando Medical Centre, in Mwanza. Staff involved in that project who subsequently created Women’s Dignity, heard time and again that fistula was not just a medical problem. The girls and women with fistula at the hospital spoke about the ways that poverty undermined their capacity to stay healthy, to be safe, and to live with dignity.

Their stories illustrated how fistula is rooted in social, economic and political inequalities that lead to poverty and vulnerability. These girls and women taught us that in order to make a meaningful difference to their lives, fistula programs needed to address far more than just the medical manifestations of health. Action would be needed to redress the basic inequalities that keep marginalized people at risk of death and disability.

Putting fistula on national and international agendas.

Since the late 1990s, Women’s Dignity has promoted fistula as an issue of human rights. We have sought to enable women living with fistula, and people living in poverty, to voice their concerns and claim their health rights.

Women’s Dignity has helped to establish fistula on national and international agendas through strategic partnerships with the World Health Organization, United Nations Population Fund (UNFPA), EngenderHealth, International Federation of Gynecologists and Obstetricians, and other groups committed to strengthening health systems and maternal health programs in developing countries.

And change is evident. Public discussion about fistula has shifted from fistula as a medical condition, to fistula as a matter of women’s basic human rights. Research on fistula has expanded, including through such studies as “Risk and Resilience: Obstetric Fistula in Tanzania” and “Sharing the Burden: Ugandan Women Speak About Obstetric Fistula”. Comprehensive programs including prevention, treatment and rehabilitation of women living with fistula are being launched by partners in many countries of Africa and South Asia. Advocacy on fistula is expanding through local, national and international media efforts. For girls and women affected by fistula, this advocacy has resulted in knowing when and where fistula treatment is available – and more women returning to lives of dignity.

Lastly, major international partners have joined the call to eliminate fistula, including through the Global Campaign to End Fistula of UNFPA in more than 40 countries, and the Fistula Care project of EngenderHealth in ten countries. Many governments have committed funds to eradicating fistula, including the Netherlands, Norway, Spain, Sweden, U.K. and U.S.A. In addition, a growing number of individuals around the world are contributing to this effort.

The challenge ahead

A vast amount of work is still needed to redress persistent health inequities and to prevent maternal deaths and disabilities such as fistula from occurring. Statistics show virtually no improvement in maternal health over the past decade in many countries of the global south. Many countries will probably fail to achieve the Millennium Development Goal (MDG) #5 aimed at reducing maternal mortality and morbidity ratios by three quarters by 2015.

Moreover, the underlying inequalities that result in conditions like fistula continue to exist. Recent data from the 2005 Tanzania Demographic and Health Survey, and the Women’s Dignity study, “Fair’s Fair: Health Equity and Inequalities in Tanzania” confirms that large health disparities persist between higher and lower income groups, and between people living in urban and rural areas.

In Tanzania, selective gains have been achieved in recent years to build governance and accountability structures and improve some aspects of basic social services like education and health. At the same time, significant gaps remain in alleviating acute poverty, particularly for girls and women. The gap in health outcomes between Tanzania’s rich and poor are significant, and mechanisms for ensuring accountability of policies, programs and services are weak.