On International Day to End Obstetric Fistula, Tostan Shares What Works

Over the past few years, Tostan has enabled hundreds of women suffering from fistula to receive medical treatment at UNFPA fistula repair camps by covering some of the essential expenses involved in seeking the treatment, such as transport to distant health facilities, food and lodging for accompanying caregivers, and additional medical costs (special prescriptions, hygiene kits, post-operative medicines). Without this support, many women would have been unable to access the treatment they needed.

Obstetric fistula is preventable; according to the World Health Organization, it can largely be avoided by timely access to obstetric care, delaying the age of first pregnancy, and the cessation of harmful traditional practices. Tostan helps communities at the grassroots level to prevent fistula in all three ways.

Tostan’s approach is holistic and integrated, and learning about fistula prevention is made possible through its three-year Community Empowerment Program (CEP). In the CEP, community members engage in dialogue around important issues related to the wellbeing of their community. They discuss human rights and responsibilities and learn about good health practices, as well as gaining skills in reading, writing, math and project management.

Tostan participants learn specifically about fistula during the health module — what it is and how to prevent it — and realize that child marriage leading to early pregnancy can be a cause of fistula if the girl does not have access to adequate health care. Because participants have learned about their human right to health and are empowered to speak up and voice their opinion on ending practices which do not lead to the wellbeing of their community, they have the courage to lead campaigns on the importance of ending child marriage and female genital cutting in their community and beyond.


A Tostan CEP participant speaking publicly about the Human Right to Health.


Tostan’s results show how interrelated health, gender and social development issues are, and that solving them sustainably requires empowering communities to address the root causes of these interconnected issues. Empowerment through human rights learning, sharing important health information and the promotion of dialogue as well as collective decision-making, lead to the reduction of harmful practices while sparking better health outcomes and preventing the occurrence of fistula. Thanks to Tostan’s Community Empowerment Program, implemented from 2013–16 in five West African countries, 150 participating communities together with 208 neighboring communities chose to organize six public declarations to abandon child marriage and female genital cutting.

Earlier this year, Tostan produced “Savoir et Agir”, from Knowledge to Action, together with partners including Senegal’s Ministry of Health, UNICEF, and UNFPA. The booklet includes understandable pictures and local language information in Pulaar and Mandinka. Four pages are devoted to explaining fistula and its prevention. Tostan shared 10,000 copies with communities early this year, as part of the movement to end obstetric fistula in Senegal.