Senegal: Right of access to information should be at heart of fight against obstetrical fistula

On the occasion of the international day against obstetrical fistula, ARTICLE 19 reiterates the importance of the right of access to information and calls on the authorities to take effective measures to adequately inform communities about the causes and the existing mechanisms to cure and prevent this injury that affects women so negatively.

Obstetrical fistula is an injury in the women's bladder or rectum caused by a long and difficult birth delivery; sometimes women in rural and disadvantaged areas stay without adequate obstetrical medical intervention during labor. This injury has different causes, among them early marriages and pregnancies or female genital mutilations. However, its causes are not well known by the majority of the population, especially by those people leaving in rural and disadvantaged areas. Usually the regions more affected are the most remote ones and with higher levels of poverty. Those are regions where access to medical care is difficult and where negative cultural practices continue to be imposed to young girls and women.

The Senegalese government, together with international and national organisations, has undertaken some actions to fight obstetrical fistula. These actions include free fistula reparation treatment across the country. However, the results of these actions have not been as expected. Each year, hundreds of women continue to suffer from this injury because of lack of information or because of not having access to the right information regarding prevention, treatment or rehabilitation. (It is estimated that in Senegal 400 new cases are found each year. According to the experts we spoke to, most of the cases are in the regions of Tambacounda and Kolda).

According to a survey conducted by ARTICLE 19 in Tambacounda, many people have never heard about obstetrical fistula and many of those that knew about the injury did not know that there is a possibility for reparation treatment and that this is free.

On a sample of 290 people that were interviewed, including 190 women, 32 knew about the injury and 26 had already asked for information about that.

In fact, ARTICLE 19 has confirmed in the field that many women do not know where to go or which procedures to follow for accessing treatment. The injury is still surrounded by mysteries, taboos and false information regarding its origins. This has led some communities to isolate and stigmatise those women who are affected by the injury, making difficult their treatment and social rehabilitation. In fact, many of the affected women do not receive any kind of support and do not know about the opportunities to access free treatment services.

In a series of recent actions undertaken by ARTICLE 19 in Tambacounda (research, surveys and workshops) the organisation has been able to confirm its assumption that the right of access to information is a central pillar that could enable people, mainly women suffering from fistula to know better their health status and reproductive rights and to access medical care.

Going to medical structures to look for information is not a common practice in Senegal, especially in regions such as Tambacounda. According to most of the people interviewed, it is difficult to ask for information when they do not know where to channel their request and what procedures and formalities are in place. In addition, there are also other inhibiting factors such as poverty or illiteracy.

After exchanges with local communities during the activities implemented by ARTICLE 19, participants started to share the information gathered and to support other women from their villages. The brother of a women suffering from fistula was invited by a participant who took part in the activities to talk about his sister's situation during the second day of the workshops on 23 March 2013. Many participants, among the 58 members of the civil society and community focal points who took part said that the exchanges and the workshop gave them strength and tools to seek information about their health status, to break the silence and to get closer to women affected to share with them the information gathered. At the end of the workshops, ARTICLE 19 visited the homes of two women who were identified as suffering from fistula, we have referred their cases to the medical authorities and have been following them closely.

Taking into account the fact that the right of access to information is a key element to promote and guarantee the right to public health services, especially maternal health, ARTICLE 19 urges:

The Senegalese government to adopt a national access to information law as well as putting into place a proactive policy to share information and to facilitate access of disadvantaged communities to public services, including health. Women should be at the heart of this policy and information should be made available into local languages and in formats that enable all social groups to use them.

Health authorities should encourage dialogue and exchange of information with their patients to ensure better implementation of women's reproductive rights, especially those ones that live in rural and disadvantaged areas.

National and regional health authorities to facilitate people's access to medical structures including in rural areas. As well as improve medical services available in the region of Tambacounda and in other disadvantaged places and provide them with sufficient qualified medical staff.

NGOs and other partners to encourage an inclusive approach with grass roots organizations in order to promote local participation and ownership in the fight against fistula in Senegal.

Government authorities to further sensitise communities about the law against early marriage and FGM and implemented them.

Notes

Since June 2012 ARTICLE 19 Senegal/West Africa Office has been working on a pilot project on sector application of the right to access information and maternal health, particularly on obstetrical fistula in the region of Tambacounda. In February 2013, during the field visit, ARTICLE 19's team met with health authorities, medical staff, local NGOs and grass roots organisations and patients. During the second visit in March 2013, capacity building activities were conducted to reinforce communities' capacities in accessing information regarding this injury. Besides the trainings, other complementary activities took place; they included, field survey, awareness raising activities on public transport and in surrounding villages and using local media and cell phone to send SMS on the injury (2000 SMS were sent during the course of the programme). The CSO workshop was supplemented by a focus group discussion that was organised in a popular suburb of Tambacounda where cultural practice of female genital mutilation and early marriage are still practiced. A group of traditional leaders,traditional birth attendants and youth groups took part in the discussions.

For additional information on our work and about access to information and the fight against obstetrical fistula in Senegal, visit our website: www.article19.sn

Or contact Fatou Jagne Senghor, ARTICLE 19 Senegal/ West Africa Director [email protected] or Khadidiatou Diaw, Senior Programme Assistant [email protected] or +221338690322