This article describes a comprehensive project developed by a group professionals from Tanzania, which aims to mobilize action on vesico-vaginal fistula in the context of girls' and women's right to health. The first phase of the project ran for 18 months and included major activities. The project staff underwent intensive "hands-on" training together with an experienced surgeon or nurse. The method of training and service delivery was proven to be both effective and efficient, with approximately 150 girls and women treated during 1997-98. The project also conducted a study in order to advocate for better prevention and treatment. Furthermore, the Tanzania Midwives Association, in collaboration with the project, conducted an educational outreach with health workers throughout Mwanza Region. The project also produced a highly popular pocket-sized booklet and information sheet on vesico-vaginal fistula. The project seeks to break the silence surrounding vesico-vaginal fistula through an awareness program at the community, national, regional, and international levels. This includes painting provocative public murals and dissemination of information regarding vesico-vaginal fistula through the media.
The problem of maternal ill-health is growing all over the world, especially in developing countries. Data from the international workshop on vesico-vaginal fistulae cited that there are 2 million women suffering from fistulae, 200,000 of them in Nigeria. In response to this crisis, fistula-treating hospitals have been set up and training of doctors is taking place in several countries in Africa. However, maternal morbidity and mortality rates in sub-Saharan Africa are not decreasing. This situation is mainly attributed to poverty, wherein the basic essentials such as food, water, and sanitation are lacking. Yet, a number of health care providers are doing their job very well. Noteworthy, for instance, is the introduction of well supervised, trained traditional birth attendants, which resulted in a decline in maternal mortality in a rural area in Nigeria; clinics that have been staffed by trained midwives and follow strict protocol guidelines; health care programs that have provided better education, better antenatal care, and better use of community health workers in Ethiopia; and the building of maternity waiting homes near maternity hospitals for women considered to be at risk.
This article examines the influence of the Lithuanian Association of Obstetrics and Gynecology (LAOG) on reproductive health care in Lithuania. In 1992, a perinatal program introduced by LAOG to reduce perinatal and infant mortality was started. LAOG concentrated on improving the quality of care provided by doctors and midwives, as well as encouraging breast-feeding initiatives. In 1994, LAOG and the Lithuanian branch of the International Planned Parenthood Federation organized a conference on the medical and social aspects of family planning involving doctors, midwives, women's group leaders, and psychologists. Education and seminars for teenagers regarding contraception and sex were also conducted by midwives. Furthermore, conferences were organized to discuss solutions to the problem of sexually transmitted diseases and the proper management of pelvic inflammatory disease and other avoidable causes of infertility in women. Such meetings have brought the knowledge of health professionals up to date with regard to the latest developments. Materials from these conferences and seminars have also been published in a journal produced by LAOG in order to disseminate the information.
A UN refugee agency supported a review that aims to strengthen safe motherhood services for women refugees in northwest Tanzania. The review, which utilized the safe motherhood needs assessment of WHO as a guide, found that antenatal care as well as labor and delivery services were both available and accessible to women in the refugee camps. However, certain aspects of care could be improved by introducing a shorter schedule of visits. Limiting the use of unqualified care providers was also suggested since this practice increases the risk of disability and death. Furthermore, most of the camps tended to neglect postnatal care, and none of them had written guidelines for care of the mother and newborn. However, draft guidelines were formulated as the review progressed. Up-to-date technical information was also given to staff members to maintain quality care. This review of safe motherhood services demonstrates that it is possible to provide good quality services for children and mothers even in difficult situations. Such services do not require enormous financial resources, neither do they require sophisticated technology and highly specialized staff.
This article summarizes findings from a randomized control trial to determine the effect of a chosen female provider on the outcome of labor in Botswana. Botswana has a long cultural tradition, according to Setwana custom, of women being present during the pregnancy and after the delivery of the first born. However, hospitals in Botswana do not permit female family members to stay with women during labor and delivery. In fact, hospitals do not allow caretakers to enter the labor ward. The trial was conducted during October 1994 and January 1995, among 109 women in their 37th-42nd week of pregnancy. None of the women had complications. The control group received the normal hospital treatment. The experimental group received the normal treatment plus the constant presence of their chosen female relative. Findings indicate that the experimental group women were more likely to have an intervention free vaginal delivery. Women in the control group had greater risk of obstetric interventions. The study did not evaluate women's perceptions of the intervention or desire for other support persons. Findings indicate that companionship during labor produces positive outcomes that would avoid costly obstetric interventions.
