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Madagascar

High teenage pregnancy rates—paired with grinding poverty—suggest that fistula will be a serious issue in Madagascar for years to come.

Why We Work in Madagascar

The island of Madagascar is home to some of the most diverse plant and animal life in the world. But its people face extreme poverty—three-quarters of the population live on less than $1.25 per day. In a country of over 24 million people, where there are not enough doctors to meet the demand for basic maternal health care, childbirth can be a life or death matter.  

Only 44.3% of births are attended by a skilled professional. This—combined with the country’s high fertility and teenage pregnancy rates—suggests that obstetric fistula is likely prevalent. 

Tragically, many Malagasy women who develop fistula are hesitant to seek treatment even if it is available, due to a common belief that surgeons only operate to steal a patient’s kidney or other body part. Additionally, Madagascar’s infrastructure is poor, making rural patients’ travel to the hospital both difficult and costly. As a result, women often suffer for years with obstetric fistula, in isolation and shame.

What You Help Us Do

We are investing in the following areas to build Madagascar’s in-country medical services and provide life-transforming surgery to as many women as possible:

Meet Our Partners

We are currently partnering with SALFA to deliver fistula treatment to women in Madagascar.

What projects are we currently funding?

Sampan’Asa Loterana momba ny Fahasalamana (SALFA)

Sampan’Asa Loterana momba ny Fahasalamana (SALFA) is the health department of the Malagasy Lutheran Church. Coordinating the activities of 10 hospitals, nearly 20 urban dispensaries, and 15 rural health clinics, they cover 21 out of 22 regions of the island. Six of SALFA’s 10 hospitals provide routine fistula treatment.

Who are our past partners?

Hopitaly Vaovao Mahafaly, Mandritsara

Opened in 1996 in Mandritsara, a town of 30,000 people, Hopitaly Vaovao Mahafaly (HVM), also known as the Good News Hospital, is the chief healthcare provider for a radius of approximately 200km. Some patients live locally, while others travel the 200 km or more to get there, often taking several days. Among other specialized services, HVM offers two operating theatres and a maternity ward.

Freedom from Fistula

In the past, we have provided grant support to Freedom from Fistula and several hospitals through Operation Fistula.

Our partner Freedom from Fistula has supported fistula treatment in Madagascar since 2014, through a partnership with Mercy Ships, a traveling charitable hospital providing free medical care to African coastal regions. In late 2016, Freedom from Fistula established a permanent Fistula Care Center in Madagascar at the Centre Hospitalier Universitaire Toamasina (CHUT), a hospital on the island’s east coast. Funding from Fistula Foundation covered the cost of surgery for 100 women at the new center, as well as pre- and postoperative care.

Through our partner Operation Fistula, a two-week fistula clinic was organized in August 2013, and a percentage of these surgeries were funded by Fistula Foundation. The clinic was held in southeastern Madagascar, as this is an area known to have a high prevalence of fistula based on a survey conducted by UNFPA. It included operations from both local and internationally renowned fistula surgeons, the former of which continued to provide obstetric fistula repair surgery throughout the year at their own hospitals under this grant.

How much funding have we granted?

SALFA

  • $450,000 in FY2019
  • $391,613 in FY2018
  • $25,000 in FY2018
  • $207,500 in FY2017
  • $75,000 in FY2016

Hopitaly Vaovao Mahafaly

  • $4,500 in FY2018
  • $6,500 in FY2016

Freedom from Fistula

  • $179,473 in FY2016

Latest Updates from the Field

Mother's Day - You Did It!  •  August 01, 2019
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1,000 women in Madagascar will receive life-changing surgery! It was a joyful Mother’s Day indeed! Thanks to supporters like you, a record breaking 1,000 women will receive fistula surgery in...
1,000 women in Madagascar will receive life-changing surgery! It was a joyful Mother’s Day indeed! Thanks to supporters like you, a record breaking 1,000 women will receive fistula surgery in Madagascar. A generous family matched donations, and because of our compassionate community, our partners in Madagascar will have the resources they need to keep up with an exploding demand for fistula treatment. On behalf of all of us here at Fistula Foundation—and most importantly, the women we serve—thank you! This story originally appeared in the Summer 2019 edition of our newsletter, Transformations.
This Mother’s Day, Make Sure That No Suffering Mother is Turned Away  •  April 07, 2019
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Women in Madagascar Urgently Need Your Help. In Madagascar, too many women are robbed of the joys of motherhood. Without access to adequate maternal healthcare, they are at a high...
Women in Madagascar Urgently Need Your Help. In Madagascar, too many women are robbed of the joys of motherhood. Without access to adequate maternal healthcare, they are at a high risk of developing obstetric fistula—uncontrollably leaking urine and sometimes feces. Their babies rarely survive. What’s more, Madagascar has a high teenage pregnancy rate, and many of our patients are very young. Older patients have often suffered for decades. It doesn’t have to be this way. Our hospital partner, SALFA, is providing high-quality fistula surgery to women in need. Word is spreading throughout the island—thanks to healed patients who have become fistula advocates in their communities. As a result, demand for surgery has exploded. We need to find more resources so that Malagasy women can receive the treatment they desperately need. This Mother’s Day, will you join us to support this lifeline for young mothers in Madagascar? A generous donor family will MATCH your gift up to $200,000— but only before Mother’s Day on May 12th. Stay tuned to learn more about how you can help! This story originally appeared in the Spring 2019 edition of our newsletter, Transformations.
Your Donations at Work - Madagascar  •  January 30, 2018
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Obstetric fistula happens most frequently in rural areas, where emergency medical care is not easily accessible. A woman’s risk of developing fistula is also exacerbated by cultural misunderstanding about doctors...
Obstetric fistula happens most frequently in rural areas, where emergency medical care is not easily accessible. A woman’s risk of developing fistula is also exacerbated by cultural misunderstanding about doctors and surgery. Madagascar faces both of these challenges: its infrastructure is poor, which can make travel to the hospital complicated and dangerous.
Meet Rasoanirina from Madagascar  •  December 14, 2017
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Rasoanirina was in primary school when she became pregnant at the age of 17. Her prolonged obstructed labor ended at a nearby hospital, where she received a C-section to deliver...
Rasoanirina was in primary school when she became pregnant at the age of 17. Her prolonged obstructed labor ended at a nearby hospital, where she received a C-section to deliver the baby. She began leaking urine almost immediately after the baby was removed. Extremely shy, and embarrassed by her condition, Rasoanirina stopped going to school.
Meet Romenisoa from Madgascar  •  December 14, 2017
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During her fifth delivery, Romenisoa's labor did not go as planned, and as a result, she developed obstetric fistula. She is not married, explaining that “no man will live with...
During her fifth delivery, Romenisoa's labor did not go as planned, and as a result, she developed obstetric fistula. She is not married, explaining that “no man will live with me because I have this problem.” It was also difficult for her to live with other people because of her smell and the constant need to change her clothes.
Meet Rose from Madagascar  •  December 14, 2017
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Rose lives in Vohitrambo Village, about 15km from the nearest hospital in the small village of Vangaindrano. She developed obstetric fistula at the age of 16, during her first delivery....
Rose lives in Vohitrambo Village, about 15km from the nearest hospital in the small village of Vangaindrano. She developed obstetric fistula at the age of 16, during her first delivery. Like most women in her community, she had given birth at home under the care of a traditional birth attendant. But her labor did not progress as expected and Rose endured painful labor for three days.
Meet Francine from Madagascar  •  December 13, 2017
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She became pregnant with her first child around age 17. Things did not go as planned, and Francine found herself in labor for three days. Finally, she was taken to...
She became pregnant with her first child around age 17. Things did not go as planned, and Francine found herself in labor for three days. Finally, she was taken to a hospital where her baby was delivered via C-section. As a result of her prolonged obstructed labor, Francine had developed an obstetric fistula.
Meet Ndatsaha  •  December 13, 2017
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Ndatsaha developed fistula when she went in to labor with her third child. She sought the services of a traditional birth attendant, as she had with her previous pregnancies, and...
Ndatsaha developed fistula when she went in to labor with her third child. She sought the services of a traditional birth attendant, as she had with her previous pregnancies, and as most women did in her community. But this time, things were different. The baby did not come, and Ndatsaha labored in excruciating pain for three days. Ndatsaha is from the village of Manja, about 250km from the nearest large city, Morondava. She developed fistula when she went in to labor with her third child. She sought the services of a traditional birth attendant, as she had with her previous pregnancies, and as most women did in her community. But this time, things were different. The baby did not come, and Ndatsaha labored in excruciating pain for three days. One month later, she realized that she had begun to leak urine. She sought treatment, first with the local health provider in her village, but he could not help. He gave her medicine, injections, tablets – none of which worked to stop her incontinence. She tried is recommendations for two years before giving up. She thought her condition was incurable, and resigned herself to live with it. But life was not easy for Ndatsaha. Her family was supportive of her, but most of her friends rejected her because of her condition. Other members of her community would tell her to go away because she was leaking, and because she smelled. It was difficult for her to move around – and besides, she was scared to leave her home – so she stayed in the house most days. But then she learned from neighbors about SALFA and care they provided to women like her at their hospital in Morondava. She was willing to try anything. The SALFA hospital in Morondava reimbursed her for the cost of her transport to their facility, Ndatsaha said. They provided her with food and good care. Here, she finally received treatment that cured her obstetric fistula. As she healed from surgery, Ndatsaha found herself sitting with four other women recovering in the fistula ward. They shared their stories with each other, and decided that they needed to tell other women about their experience and the help they had received. That day, they decided to become fistula ambassadors. Post-surgery, Ndatsaha feels very good. She feels strong. And she feels “cool” now that she is able to wear shorts again – something she had avoided when she had fistula, opting instead for long skirts to hide the trickle of urine that leaked down her legs. She even participated in a Health Awareness Day that was organized in Morondava by SALFA. She was invited as an ambassador and spoke to the audience about fistula, what it is, and how SALFA could help. She encouraged others to come for treatment. During the event, she was interviewed by media and felt an outpouring of respect – something she hadn’t felt in years. Today, she is considered one of the hospital’s best ambassadors, having referred more than 5 women for treatment.
Field Notes: On the road in Madagascar  •  April 19, 2017
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I’m going to introduce you to Vavizely in a second. I warn you, her story is fairly difficult to imagine and a little hard to take. I met Vavizely at...
I’m going to introduce you to Vavizely in a second. I warn you, her story is fairly difficult to imagine and a little hard to take. I met Vavizely at Freedom from Fistula’s surgical center in Toamasina, Madagascar. Toamasina is a compact, neat, prosperous coastal town, the commercial capital and main port of Madagascar, and is blessed with a decent medical system.
Photo Gallery: Changing Lives in Madagascar  •  January 23, 2017
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Despite being known for its rich biodiversity, Madagascar’s people face extreme poverty three quarters of the population live on less than $1.25 per day. Fertility rates are high, and child...
Despite being known for its rich biodiversity, Madagascar’s people face extreme poverty three quarters of the population live on less than $1.25 per day. Fertility rates are high, and child marriage is prevalent in poor, rural areas. Many women lack access to skilled health care providers during delivery, significantly increasing the risk of childbirth complications like fistula.

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