Educating and Empowering Women

Helping women gain greater power - and providing them with more options in life - are keys to improving reproductive health generally and reducing fistula.

In countries where fistula is common, women may have little control over their own lives. They may also have little control over how resources are spent, in spite of their considerable paid or unpaid labour. And in the rural areas where fistula is most common, communities may be tightly bound by cultural practices and traditions, some of which make it difficult for women to protect their reproductive health.

In many cases, husbands, brothers or other family members make important decisions, including those having to do with childbirth. They may be poorly informed about the risks of childbirth and the need for medical care. Informing men about reproductive health issues through community-based advocacy activities can encourage and empower them to be better partners in this regard.

In some cultures, women cannot even leave the house without the permission of the husband, father or in-laws. Girls are less likely to complete their education than boys. Girls and women are also less likely than boys and men to get enough to eat. The resulting malnutrition or anaemia may stunt growth and contribute to poor pregnancy outcomes.

It's one thing to repair the horrific physical damage. It's harder but even more urgent to prevent the damage in the first place. That means confronting the social and economic ills that underlie girls' and women's vulnerability to fistula.

—Maggie Bangser, Women's Dignity Project, Tanzania

Power dynamics affect reproductive health

In places where women can freely make decisions about their reproductive lives and where they can pursue school or work, they overwhelmingly choose to delay the birth of their first child and to have fewer children. Both choices lead to fewer problems with childbirth, and to healthier mothers, children and families.

Education is a powerful lever to empower women in other ways as well. Educated women understand the need for appropriate care during pregnancy and childbirth. They have more power to assert and protect themselves. Improving women's education helps reduce fertility and child malnutrition and improve maternal and child survival.

Eritrean girl's story

When the contractions started, the doctor said, "Her opening is much too narrow. Her parents must have arranged her marriage when she was too young." And it is true. I got married when I was 16, because my father arranged it. The doctor pulled the baby out by force, but she was alive. I had a big, big tear, and they sewed it together. But right away I had a big problem. I could not control my faeces any more.

—From 'Mending Torn Lives', a UNFPA/Eritrea publication

What the Campaign is doing

UNFPA and many of its partners in the Campaign to End Fistula also work to promote gender equality, which is one of the eight Millennium Development Goals agreed upon by world leaders in 2000. A benchmark for achieving this is equality in girls' and boys' enrolment in primary and secondary schools. UNFPA efforts to promote girls' education also tend to delay too-early marriage and pregnancy.

UNFPA is a powerful advocate for women in all the countries it serves. It also recognizes that changing deeply entrenched traditions requires sensitivity and patience. In many countries, UNFPA works with influential community and religious leaders and traditional healers and midwives, who in turn, can be very effective in mobilizing support for women's right to reproductive health.