This report evaluates the results of integrating postabortion care and family planning to emergency obstetrical and neonatal care in Benin from 2002-2005.  The evaluations were conducted at three pilot sites, each located at a specific level of Benin’s health system: at the national level, the Hospital of the Mother and the Child, Lagune (HOMEL); at the departmental level, the Departmental and University Hospital Centre (DUHC) of Borgou/Alibori in Parakou; and at the peripheral level, the maternity clinic of the Community Health Centre (CHC) of Parakou.

One of the most common, yet treatable, causes of maternal death worldwide is pre-eclampsia—the rapid elevation of blood pressure during pregnancy—which, if untreated, can lead to seizures (eclampsia), kidney and liver damage, and ultimately, death. Approximately 63 000 pregnant women die every year because of eclampsia and severe pre-eclampsia, which are also associated with a higher risk of newborn death. Based on the latest scientific evidence, the World Health Organization (WHO) has recommended magnesium sulfate as the most effective, safe, and low-cost medication to treat eclampsia and pre-eclampsia. While magnesium sulfate has been the standard treatment in the developed world for the past 20 years, less-effective and riskier medications (such as diazepam and phenytoin) are still widely used for these conditions in most developing countries. This is yet another example of the enormous disparity in the quality of maternal health care between industrialized and poor nations. Earlier this year, in response to this issue, EngenderHealth, an international reproductive health organization, and the University of Oxford brought together leading scientists, advocates, researchers, and representatives of the WHO, UNICEF, United Nations agencies, and national ministries of health from around the world to identify country-specific barriers to the availability and use of the drug, as well as factors that facilitate its utilization in settings where magnesium sulfate is not the treatment of choice within public health systems.  This report details barriers and solutions to treat pre-eclampsia and eclampsia.

The purpose of this study was to understand the many dimensions of fistula and its related social vulnerability through the experiences and views of girls and women living with fistula as well as their families and communities and the health workers who care for them. The study also explored participants’ recommendations on locally appropriate solutions to prevent and manage fistula.

Each and every pregnancy is a risk and life threatening condition for a woman. In the under developed countries like ours (Bangladesh) obstetric fistula is one of the devastating pregnancy-related morbidity. While the proximate causes of fistulas are physical injuries, the larger causes are social i.e poverty, lack of education, childbearing at too early age and lack of medical care. In many rural areas, girls are married off just after they experience their first menstrual flow between 10 and 15 years of age. These girls become pregnant which leads to many unwanted conditions including mortality and long term morbidity like obstetric fistula. Medical facilities are not trusted, or may be used only as a desperate last resort when damage is already far advanced. This report on "Situation Analysis of Obstetric Fistula in Bangladesh" is the first attempt to find out the obstetric fistula situation in Bangladesh was undertaken by UNFPA (United Nations Population Fund) and EngenderHealth. This report finds that the number of women living with fistula is estimated to be 1,69 per 1000 ever married women. This number is not a meager figure. However there is a need of a comprehensive study to find out the actual prevalence of obstetric fistula in Bangladesh.

The Eastern region of the Democratic Republic of Congo (DRC) is currently undergoing a brutal war. Armed groups from the DRC and neighbouring countries are committing atrocities and systematically using sexual violence as a weapon of war to humiliate, intimidate and dominate women, girls, their men and communities. Armed combatants take advantage with impunity, knowing they will not be held to account or pursued by police or judicial authorities. A particularly inhumane public health problem has emerged: traumatic gynaecological fistula and genital injury from brutal sexual violence and gang-rape, along with enormous psychosocial and emotional burdens. Many of the women who survive find themselves pregnant or infected with STIs/HIV with no access to treatment. This report was compiled at the Doctors on Call for Service/Heal Africa Hospital in Goma, Eastern Congo, from the cases of 4 715 women and girls who suffered sexual violence between April 2003 and June 2006, of whom 702 had genital fistula. It presents the personal experiences of seven survivors whose injuries were severe and long-term, with life-changing effects. The paper recommends a coordinated effort amongst key stakeholders to secure peace and stability, an increase in humanitarian assistance and the rebuilding of the infrastructure, human and physical resources, and medical, educational and judicial systems.

A fact sheet for program managers and policy makers about active management of the third stage of labor for prevention of postpartum hemmorrhage.

This manual is written for clinical staff or administrators working in emergency obstetric care (EmOC) facilities, who currently assume - or are being asked to take on - a leadership role among staff providing EmOC.  You may already be in a supervisory role, either as part of your main job, or from time to time as a 'task supervisor', or your position may not normally include these activities.  Regardless of your official titel or current clinical or administrative role in coordinating the process outlined in this manual, you are being called upon to function as a leader of the EmOC staff to improve services.  This manual and its accompanying toolbook will help you to: 1) Introduce, demonstrate, and maintain a quality improvement process with the team of staff that provide EmOC services; 2) Use facilitative leadership and communication skills to structure the work environment to encourage teamwork; 3) Problem solve with the EmOC team rather than make unilateral decisions; 4) Encourage individual excellence of EmOC staff at all levels through leading by example, mentoring, coaching, and other capacity-building skills; and 5) Coordinate input from external supervisors and technical specialists so that their input conttributes to improving the quality of care at your facility.

This toolbook contains a set of tools and instructions for use in gathering and analyzing information to assess the quality of care in emergency obstetric care (EmOC) facilities. With the information gathered through these tools, staff can work together as a team to identify problems and implement solutions according to the continuous Quality Improvement process described in Chapter 3 of the companion volume, "Quality Improvement for Emergency Obstetric Care: Leadership Manual, and summarized later in this chapter.  The tools in this toolbook include: 1) EmOC Assessment; 2) Client/Family Interview; 3) Registers and Records Review; 4) Client Flow Analysis; and 5) Brief Case Review Guidelines

The meeting had four specific objectives: 1) To share current knowledge on the magnitude of traumatic fistula; 2) To discuss existing programmatic interventions; 3) To identify key successes, challenges, and gaps related to clinical, psychosocial, community, policy/advocacy, and referral and related issues; and 4) To synthesize lessons learned, develop recommendations to address the identified gaps, and develop country-specific strategies to address traumatic fistula.

Fistula Monitor Form.

EngenderHealth has composed a presentation explaining why an E-Learning module would be essential to the prevention of pre-eclampsia

A fact sheet explaining what fistula and what EngenderHealth is doing to treat it.

Compass, 2003, No. 1. Intended broadly for the professional community involved in international public health and development, Compass is a periodic publication featuring snapshots of the results of EngenderHealth's work in the areas of family planning, prevention of HIV and other sexually transmitted infections, and maternal care. This issue reports on how women suffering complications from incomplete abortion were managed with a greater degree of clinical safety, efficiency, and humanity, thanks to a program called Prevention and Management of Abortion Complications (PMAC). Developed and implemented in the Philippines by EngenderHealth in collaboration with the nation's Department of Health, PMAC also promoted an evolution in providers' attitudes and values, which led to improved counseling skills, better care for postabortion clients, and increased use of manual vacuum aspiration in the clinical treatment of complications.

A useful tool comparing the various manual vacuum aspiration (MVA) instruments on the market, to help providers and those procuring supplies choose the equipment that best suits their needs. Describes the test procedures and standards used to evaluate the instruments, provides an overall comparison of the instruments evaluated, lists the cross-compatibility of equipment from various manufacturers, and provides information about the products and their manufacturers.

A report summarizing two studies conducted by EngenderHealth in the Dominican Republic and Malawi to determine how facilities can better meet adolescents' needs for postabortion care (PAC). Contains results from interviews with adolescents who received PAC services and providers who deliver them. Includes recommendations for improving adolescent PAC services.

This is a report on Obstetric Fistula in Amhara Regional State, Ethiopia from January 2006 to March 2007.

While global awareness about obstetric fistula—a vaginal tear resulting from prolonged obstructed labor— has increased, less is known about traumatic gynecologic fistula, a condition that can occur as the result of sexual violence, often in conflict settings. Brutal rape (including the use of gun barrels, beer bottles, or sticks) can result in a tear or fistula between a woman’s vagina and bladder or rectum, or both. Due to the fistula, these women are unable to control the flow of their urine and/or feces and find it impossible to keep clean. As survivors of violent sexual assault, women with traumatic fistula may have sustained additional physical injuries and are at an increased risk for unwanted pregnancy and sexually transmitted infections (STIs), including HIV. Often divorced by their husbands, shunned by their communities, and unable to work or care for their families, survivors must also cope with the psychological trauma caused by rape.

Frequently, a surgical procedure is all that is needed to repair the physical injury. More long-term and comprehensive counseling, rehabilitation, and advocacy services are also critical to ensuring that a woman’s psychological wounds are healed and that her perpetrator is brought to justice.

A poster providing a clear and simple three step process to ensure the active management of the third stage of labor.

This literature review surveys the landscape of information on traumatic gynecologic fistula in conflict settings. It was prepared to stimulate discussion at the upcoming meeting Traumatic Gynecologic Fistula: A Consequence of Sexual Violence in Conflict Settings, to be held September 6–8, 2005, in Addis Ababa, Ethiopia. This meeting will be sponsored by the Regional Economic Development Services Office for East and Southern Africa (REDSO), U.S. Agency for International Development (USAID).