In many rural areas, girls are married just after they experience their first menstrual flow— between 10 and 15 years of age. In some cases, early marriage for girls occurs before the onset of their menstrual cycle, as a way to ensure virginity. Postponing the age of marriage and delaying childbirth can significantly reduce their risk of obstructed labour. Better education for women and their families about the dangers of pregnancy and childbirth and the value of emergency obstetric care is crucial.
Information about family planning, sexually transmitted infections and HIV/AIDS should also be provided. Culturally sensitive advocacy campaigns on maternal health and obstetric fistula could educate communities about the warning signs of pregnancy complications and the need to get prompt medical attention. Women who have been successfully treated for fistula could also be trained to help with community outreach. Support from local and national policy makers is needed for all educational efforts.
Women have the right to education and health care. Yet girls are frequently denied schooling, which tends to delay marriage and give them skills to earn an income.
Social and cultural barriers also limit a woman’s ability to seek medical care when needed. In many communities, pregnant women require permission from their husbands or male relatives to see a doctor. Cultural beliefs around the causes of obstructed labour such as infidelity or being cursed further limit a woman’s ability to seek treatment. Legal and social change is needed to improve the status of women and provide girls with access to proper nutrition, health care and education.
Men’s involvement is crucial to achieve this change and to give young women other options in life besides childbearing.
Reconstructive surgery is a delicate procedure that requires a specialist trained surgeon and skilled nurses. Carefully monitored post-operative care is also crucial to a patient’s recovery, therefor there is an urgent need for more doctors and support staff to handle the demand for treatment.
Many hospitals rely heavily on the assistance of expatriate doctors. Local surgeons and nurses should be trained in fistula repair and their skills should be updated regularly. Midwives should immediately refer patients to emergency obstetric care when they detect obstructed labour.
Referral systems and transportation to hospitals should be established and supported. Since emergency obstetric care is especially scarce in rural areas, incentives should be offered to attract skilled medical personnel to areas with the greatest needs.
Many women with fistulas live in rural areas, far from medical help. Safe and reliable transportation to a hospital is often scarce or too expensive for poor women and their families.
Many women interviewed had travelled for months on foot, by donkey or any other means available in search of a hospital that could treat them. Better transportation and communication systems between remote villages and hospitals should be a priority. Midwives can play a key role in the referral process, but measures to get women to hospitals quickly must first be established.
Three classic delays (a delay in the decision to seek medical attention, a delay in reaching a health care facility and a delay in receiving emergency obstetric care at the facility) must be addressed in order to change the odds so that women get the high quality care they need.
Fistula surgery needs to be accessible and affordable to poor women. Some patients arrive at hospitals accompanied by family members after travelling long distances and having exhausted the last of their resources. Then they may need to find money for surgery, food at the hospital and lodging for their relatives. Poverty makes even moderate sums difficult to afford, one or two fistula centres that can provide free or subsidized services are needed. They should be located in areas that will serve the largest number of clients and should be easy to access.
Fistula survivors who have been shunned and isolated typically experience intense feelings of shame, self-loathing, mental health and depression.
They may blame themselves for their situation. Education and counselling can help restore their self-esteem after surgery. Information on family planning, the need for a C-section for future pregnancies and HIV prevention is also essential. Social rehabilitation programmes can help women reintegrate into their communities and reconnect with their families.
Economic Stimulus Development Programmes/Projects can give women the means to earn an income once they are healed and prevent them from resorting to other immoral activities such as commercial sex work to survive. Social support services, offered in conjunction with hospital care, will significantly enhance a woman’s physical and mental well-being.
FGM survivors in Narok East often endure profound psychological trauma, including depression, anxiety, and post-traumatic stress disorder (PTSD). The stigma surrounding conditions like obstetric fistula, which can result from early childbirth linked to FGM, exacerbates these mental health challenges.
Many women suffer in silence due to fear of social ostracization. For instance, some are branded as witches or isolated within their communities, leading to further emotional distress. The lack of mental health resources in rural areas compounds these issues, leaving survivors without adequate support.
NAKOFIT has been instrumental in providing support to over 300 women by facilitating access to medical treatment for fistula and offering counseling services. The organization in partnership with The Girls Generation Options Kenya on African led Movement in collaborates with local hospitals and community leaders to identify and assist affected women.
Additionally, initiatives like the “#Her Voice Matters” group conduct outreach programs in schools and churches, offering guidance and counseling to teenage mothers and FGM survivors leadership training and initiative. These programs aim to empower girls through education and provide them with the necessary resources to overcome the challenges posed by FGM.
NAKOFIT’s efforts extend beyond individual support to community-wide advocacy against FGM. By sharing her personal journey, Nampayio Koriata challenges the cultural norms that perpetuate FGM and early marriages.
Her advocacy has inspired other survivors to speak out and has led to increased awareness about the harmful effects of FGM. Collaborations with organizations like the The Girl Generation TGG-ALM further amplify these efforts, promoting survivor leadership training and empowerment and engaging community members in dialogues to end FGM.
Despite these initiatives, FGM remains prevalent in Narok County, with reports indicating that a significant percentage of Maasai girls undergo the practice. Deep-rooted cultural beliefs and secrecy surrounding the practice hinder eradication efforts.
Survivors often face stigma, and the lack of comprehensive mental health services in rural areas leaves many without the support they need. Continued investment in community education, mental health services, and enforcement of anti-FGM laws is essential to protect girls and women from this harmful practice.