Why high fertility rates in North Eastern has hand in fistula cases

Veiled. This is the only way Fatuma Abdalla would open up about the condition that cost her marriage.

Not even her husband of over seven years would understand. In 2015, he packed and left.

“If he has something to give, he gets in touch with one of the children and sends them,” she says. “But he does not step foot here.”

Fatuma’s turmoil began in 2012, she was 21 and pregnant with her first child, a girl. However, things went down south afterwards.

She could not control her bladders. A trip to the hospital left her with pills to swallow as she was told it is just an infection.

“I was in constant pain,” she says.

Before she could even find out what exactly was wrong, she was already pregnant with her second child whom she gave birth to in 2013.

The pain was severe and a procedure was done to correct the condition. She then got pregnant and in 2015 and gave birth.

And that is the mistake she did.

Dr Carrey Francis Otulo, a gynaecologist and specialist in correcting fistula said most times women do not follow the after surgery instructions.

One of the key instruction is no sex for at least six months after surgery and they should wait for a year or two before getting another child.

“But many patients do not. They go back to their routines as soon as they are out of hospital,” he said.

In the case of Fatuma, who hails from Garissa County, waiting may not have worked for her.

She happens to be one of the women who come from North Eastern region, known for its high fertility rate.

According to the Kenya Demographic and Health Survey (KDHS) 2014, North Eastern region holds the title when it comes to fertility rate with an average of six children (6.4) per every woman.

At 28, Fatuma already had three all of them in quick succession in 2012, 2013 and 2015. Though fistula cases have been documented all over the country, Otulo noted that the prevalence in North Eastern region like Marsabit, Garissa, Mandera is higher compared to other areas.

Otulo said women who desire to have more children after the fistula surgery are allowed to do so, but the delivery should be done at a hospital in the hands of a skilled birth attendant through caesarean section.

“Or there will be a rapture,” he said.

This was the other mistake Fatuma did and it raptured again once she gave birth to her third child naturally in 2015. Her husband vanished.

She could not afford Sh50,000 to have it corrected and a well-wisher facilitated her transport to have it done for free at Garissa County Referral Hospital during a medical camp organized by Amref.

“We have had cases of patients who have undergone fistula surgeries three or four times but it still recurs. This is due to poor post-operative care,” said Otulo.

He said the notion that fistula affects women who have undergone Female Genital Mutilation, which has been the case for women in North Eastern region is misleading.

“FGM by itself alone does not cause fistula but it predisposes one to fistula. FGM is usually done early and a girl married off so if they do not get a skilled birth attendant to handle them, then they might end up with fistula,” he explained.

A major cause, he said is prolonged labour, and other surgical procedures in cases of cervical cancer, or abortion cases where the instruments may cause punctures.

“For cancer one can develop fistula even during radiotherapy treatment,” he added.

Data from Amref showed that in every 120 women in Garissa, 56 have fistula which puts the prevalence at 46 per cent.

“The trend is going down due to the awareness and the quality of gynecological care. This way we work more on prevention than treatment,” said Galgalo Golicha from Amref.