Zara, 16 years old, stands in front of the referral hospital in Niamey. It has taken her 2 days to get here from her remote village in Agadez; the sun reflects the shadow at her feet. She moves but the shadow does not. A health worker, waiting to intake the next patient, looks over and realizes it is not a shadow; it is a puddle of urine that has leaked from Zara’s fistula during the short time she stood waiting her turn to be evaluated for surgery.
KeywordsCesarean Delivery Early Marriage Fistula Repair Child Marriage Skilled Birth Attendance
- Addis Ababa Fistula Hospital, EngenderHealth / The ACQUIRE Project, Ethiopian Society of Obstetricians and Gynecologists, and Synergie des Femmes pour les Victimes des Violences Sexuelles. Traumatic gynecologic fistula: A consequence of sexual violence in conflict settings. New York: EngenderHealth/The ACQUIRE Project; 2006. http://www.engenderhealth.org/files/pubs/maternal-health/tf-report-english.pdf.
- Ajobiewe K. Nigeria: cesarean operation fast replacing vaginal child delivery? 27 Nov 2011. http://allafrica.com/stories/201111280266.html. Accessed 31 Aug 2012.
- Coen B. Addressing early marriage in Niger. UNICEF, 10 Jan 2011. http://www.unicefusa.org/news/news-from-the-field/addressing-early-marriage-in.html. Accessed 31 Aug 2012.
- Dolea C, AbouZahr C. Global burden of obstructed labour in the year 2000. Geneva: WHO; 2003. http://www.who.int/healthinfo/statistics/bod_obstructedlabour.pdf
- Family Care International (FCI). Reaching out on obstetric fistula through strategic communications. Family Care International, Campaign to End Fistula, UNFPA. 2010. http://www.familycareintl.org/UserFiles/File/Reaching-Out-On-Obstetric-Fistula-English_web.pdf
- Integrated Regional Information Networks (IRIN). Niger: early marriage—from rural custom to urban business, 16 Jan 2009. http://www.irinnews.org/Report/82419/NIGER-Early-marriage-from-rural-custom-to-urban-business. Accessed 31 Aug 2012.
- Levin A, McEuen M, Dmytraczenko T, Ssengooba F, Mangani R, Van Dyck G. Costs of maternal health care services in three anglophone African Countries. Special Initiatives Report 22. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates; 2000. http://www.abtassociates.com/reports/2000230338609_35062.pdf
- Lewis G, de Bernis L, editors. Obstetric fistula: guiding principles for clinical management and programme development. Geneva: WHO; 2006. http://whqlibdoc.who.int/publications/2006/9241593679_eng.pdf
- Maine D, Wardlaw TM, Ward VM, McCarthy J, Birnbaum A, Akalin MZ, Brown JE. Guidelines for monitoring the availability and use of obstetric services. New York, NY: UNFPA; 1997.Google Scholar
- Megrahtu S. UNICEF supports efforts to eradicate child marriage in Niger. UNICEF, 12 Jul 2012. http://www.unicef.org/infobycountry/niger_65336.html. Accessed 31 Aug 2012.
- Meyer L, Ascher-Walsh CJ, Norman R, Idrissa A, Herbert H, Kimso O, et al. Commonalities among women who experienced vesicovaginal fistulae as a result of obstetric trauma in Niger: results from a survey given at the National Hospital Fistula Center, Niamey, Niger. Am J Obstet Gynecol. 2007;197(1):90.e1-4.PubMedCrossRefGoogle Scholar
- Nour NM. Child marriage: a silent health and human rights issue. Rev Obstet Gynecol. 2009. Winter;2(1):51–6.Google Scholar
- USAID, EngenderHealth / The ACQUIRE Project. Report of Fistula Counseling Experts’ Meeting March 29 & 30, 2005. New York: EngenderHealth/The ACQUIRE Project; 2005. http://www.acquireproject.org/fileadmin/user_upload/ACQUIRE/Publications/Fistula_Counseling_Mtg_Report.pdf.
- United Nations Population Fund (UNFPA). “School for husbands” encourages Nigerien men to improve the health of their families. 20 Apr 2011. http://www.unfpa.org/public/home/news/pid/7542. Accessed 31 Aug 2012.
- UNFPA. The Campaign to End Fistula: Maternal Health Thematic Fund Annual Report 2010. New York, NY: UNFPA; 2010. http://www.endfistula.org/webdav/site/endfistula/shared/documents/reports/sep-chap_fistula-may24.pdf
- UNFPA. The Campaign to End Fistula: Maternal Health Thematic Fund Annual Report 2009. New York, NY: UNFPA; 2009 http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/mhtf_2009_endfistula.pdf.
- United Nations Population Fund, Engender Health. Obstetric fistula needs assessment report: findings from nine African countries. New York, NY: UNFPA and EngenderHealth; 2003. http://www.engenderhealth.org/files/pubs/maternal-health/report/fistula-needs-assessment.pdf.
- World Health Organization. Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors. Geneva: World Health Organization; 2007. http://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf
- World Health Organization. 10 Facts on obstetric fistula. Geneva: WHO; 2010 http://www.who.int/features/factfiles/obstetric_fistula/facts/en/index.html
- World Health Organization, Global Health Observatory (GHO) Data Repository. MDG 5: Maternal Health: Births attended by skilled health personnel by country: Niger 2006. WHO. Accessed 28 Aug 2012. http://apps.who.int/gho/data/view.main.280
- World Health Organization. Making pregnancy safer: the critical role of the skilled attendant: a joint statement by WHO, ICM and FIGO. Geneva: WHO; 2004. http://whqlibdoc.who.int/publications/2004/9241591692.pdf
- WHO GHO Data Repository. Global Health Workforce Statistics: Niger 2008. WHO. Accessed 29 Aug 2012. http://www.who.int/hrh/statistics/hwfstats/
- WHO GHO Data Repository. Demographic and socioeconomic statistics: GNI per capita by country: Niger 2011. WHO. Accessed 10 May 2012. http://apps.who.int/gho/data/node.main.GNI107?lang=en
- WHO. Humanitarian Health Action: Niger: Country Profile. Geneva: WHO; 2005. http://www.who.int/hac/crises/ner/background/Niger_July05.pdf
- Zinman LN, Libertino JA. Vesico-vaginal fistula. In: Libertino JA, editor. Reconstructive urologic surgery. 3rd ed. St. Louis, MO: Mosby; 1998. p. 259–74.Google Scholar