In September 2024, the ECOWAS Gender Development Centre (EGDC), the specialized agency of ECOWAS for gender equality and women’s empowerment, committed US$245,000 to support Ghana’s Obstetric Fistula Elimination Programme. The project was officially launched in Accra in partnership with Ghana’s Ministry of Health and Ministry of Gender, Children and Social Protection, and the National Fistula Task Force Team.
This project is one of the flagship gender interventions of EGDC, which has been working since 2010 to combat obstetric fistula across West Africa. The 2024 edition in Ghana is part of a regional strategy that covers all ECOWAS Member States.
Obstetric fistula is a devastating childbirth injury caused by prolonged obstructed labour without timely emergency obstetric care. It results in a hole between the birth canal and the bladder or rectum, causing uncontrollable leakage of urine or feces. Beyond the physical trauma, it leads to profound social consequences.
According to EGDC Director, Mrs. Sandra Oulate Fattoh, the programme reaffirms ECOWAS’ commitment to the health and dignity of women and girls in Ghana and across West Africa.
Obstetric fistula is a marker of health system failure and gender inequality. It predominantly affects poor, rural, and young girls who lack access to quality maternal health care. In Sub-Saharan Africa, an estimated 2 million women live with untreated fistula. In Ghana, hundreds of new cases occur annually. The project addresses SDG 3 (Good Health and Well-being) and recognizes that access to maternal health is a fundamental human right, not a privilege.
Fistula is a gendered condition. It is rooted in early marriage, early pregnancy, malnutrition, gender-based violence, lack of female education, and women’s inability to make decisions about their own reproductive health. By investing in fistula treatment, ECOWAS directly tackles the structural gender inequalities that put women at risk. This aligns with the ECOWAS Gender Strategy and Action Plan 2020-2030.
Women with fistula face triple discrimination. They are stigmatized, abandoned by their husbands and families, isolated from their communities, and pushed into extreme poverty. They are often considered cursed. The project includes not only medical repair but also socio-economic reintegration, which restores their dignity, identity, and social status. This is critical for social cohesion.
When a woman suffers from fistula, she loses her ability to work, farm, or trade. She becomes economically dependent. By funding the rehabilitation of the Tamale Fistula Centre and providing comprehensive care, the project returns women to productive life. Studies show that for every $1 invested in fistula treatment, the community gains up to $50 in economic productivity.
This project demonstrates ECOWAS moving beyond trade and security to human development. It shows that ECOWAS specialized agencies like EGDC can directly impact lives at the grassroots. It strengthens trust in ECOWAS among citizens and fulfills the ECOWAS Vision 2050 which puts people, especially women and youth, at the centre of development.
Scaling up community outreach to educate women on antenatal care, family planning, and the importance of skilled birth attendance. Training of community health workers to identify at-risk pregnancies early.
The US$245,000 was committed for infrastructure upgrade of the Tamale Fistula Centre in Northern Ghana, where prevalence is highest. The centre was retooled to provide free surgical repair, post-operative care, counselling, and physiotherapy. Ghana’s Obstetric Fistula Prevention and Management Strategic Plan (GOFPMSP) was used as the blueprint.
This is the most innovative aspect. Survivors receive vocational training, seed capital for small businesses, literacy classes, and psychosocial support. In 2024, EGDC also linked this to its broader project of building three factories for reusable sanitary napkins and diapers across ECOWAS. These factories employ fistula survivors, turning victims into producers and entrepreneurs, ensuring sustainable income while solving menstrual hygiene challenges for school girls.
In Ghana alone, the 2024 programme targeted over 300 surgical repairs. Each surgery transforms a life. A woman who has lived 5-10 years in isolation leaking urine, unable to attend social functions, can after a 45-minute surgery become dry and regain control. The impact is immediate: restoration of physical health, mental health, and self-esteem.
One beneficiary in Tamale testified that after 7 years of living with fistula after a stillbirth at age 16, she was divorced and forced to live in a hut outside her village. After EGDC-supported surgery, she returned to school and is now an advocate for maternal health.
By preventing fistula through girl-child education and delaying early marriage, the project reduces school dropout. When mothers are healthy, their children are more likely to be healthy and educated. Breaking the cycle of early pregnancy and obstructed labour means daughters of survivors will not suffer the same fate.
The investment in Tamale Fistula Centre improved surgical capacity, trained local surgeons and nurses in fistula repair, and improved maternal referral systems. This strengthens Ghana’s overall emergency obstetric care system, benefiting all pregnant women, not just those with fistula. It is a health system strengthening approach.
The reintegration component has created a new economic model. The Reusable Sanitary Napkin Factory project, which EGDC launched in 2024 to complement fistula work, provides jobs for 50-100 women per factory. The factories produce affordable sanitary pads for adolescent girls, reducing period poverty that causes 30% of girls in rural West Africa to miss school. The elderly also benefit from affordable incontinence diapers. Thus, the project creates a circular economy: empowering women while producing goods for vulnerable groups.
The 2024 Ghana launch put fistula elimination on the national agenda. It prompted the Government of Ghana to increase its budgetary allocation for maternal health and to include fistula in the National Health Insurance Scheme discussions. At the regional level, it has encouraged other member states like Sierra Leone, Guinea, and Niger to replicate the model. It also feeds into ECOWAS’ campaign to achieve zero new fistula cases by 2030 in line with UNFPA’s global target.
By openly discussing fistula — a condition shrouded in shame and silence — the project challenges cultural taboos around women’s bodies and reproductive health. Community durbars and radio programmes organized as part of outreach have involved men, traditional leaders, and religious leaders. This engages men as allies, transforming harmful gender norms that prevent women from seeking care.
Despite its success, the project faces challenges: inadequate number of expert fistula surgeons in West Africa, poor roads preventing rural women from reaching facilities, and funding gaps. Sustainability requires that ECOWAS member states domesticate the funding rather than relying solely on EGDC grants.
The way forward proposed in 2024 is integration: linking fistula elimination with universal health coverage, girl-child education, and women’s economic empowerment programs like the ECOWAS Trade and Gender Framework (2024-2030).
The ECOWAS Gender Development Centre’s 2024 Obstetric Fistula Programme in Ghana is far more than a medical project. It is a project of justice, dignity, and restoration. Its importance lies in the fact that it addresses the intersection of health, gender, poverty, and human rights — the core of sustainable development.
Its impact is measured not only in the number of surgeries performed or the $245,000 invested, but in the number of women who can once again sit in a market, go to a mosque or church, embrace their husband, and hold their head high in their community.
In the words of Director Sandra Oulate Fattoh, “No woman should suffer a life of misery and isolation for giving life.” The 2024 project makes this statement a reality and serves as a model for how regional bodies can deliver people-centred development.
If ECOWAS is to be an ECOWAS of Peoples and not just of States, projects like this must be scaled, sustained, and celebrated.
