When Acii (not real name) began leaking urine uncontrollably after a prolonged labour at the age of 17, she did not think she was suffering from a childbirth injury. Like many young women in her community, she believed she had been bewitched.
Her family took her to traditional healers, administered herbs, and sought spiritual interventions, hoping to reverse what they thought was a curse. Instead, her condition worsened.
“My boyfriend advised me to seek help from a traditional birth attendant. I thought it was witchcraft. My family first took me to witch doctors, and we also tried traditional herbs because we believed someone had bewitched me. The condition only became worse,” Ms Sanyu recalls.
Today, Acii, now 21, is among a growing number of obstetric fistula survivors in Namayingo District using their experiences to educate teenage mothers about the dangers of delayed medical treatment and harmful cultural beliefs.
Health workers in the district say misconceptions linking obstetric fistula to witchcraft continue to prevent many young mothers from seeking timely care, leaving them to suffer in silence from a medically treatable condition.
Obstetric fistula is an abnormal opening between the birth canal and the bladder or rectum, usually caused by prolonged obstructed labour without timely medical intervention. The condition results in the uncontrollable leakage of urine or faeces and often leads to stigma, social isolation, and psychological trauma.
According to the Ministry of Health, more than 200,000 women in Uganda are living with obstetric fistula.
A long journey to recovery
For Acii, the road to recovery was long and painful. After losing her baby during childbirth, she spent months searching for a cure through traditional means before learning that surgery could repair the condition.
She sought treatment in Soroti and Jinja before eventually undergoing a successful operation during a free fistula repair camp in Namayingo.
“After all those attempts failed, I sought treatment in Soroti, then Jinja, before finally reaching Namayingo. It was my third operation, and this time I was successfully treated,” she says.
Now fully recovered, she has become an advocate for awareness.
“I want other girls to know that this is not witchcraft. It is a medical condition, and it can be treated,” she says.
Her story mirrors that of 26-year-old Awelle (not real name) from Madowa Village.
Awelle developed fistula after complications during her second pregnancy. Having successfully delivered her first child with the help of a traditional birth attendant, she returned to the same attendant during her second pregnancy.
However, prolonged labour forced her to seek emergency medical care. Doctors performed a Caesarean section, but her baby did not survive.
“I did not know what had happened to me. I was leaking urine all the time and thought it was witchcraft,” she says.
The condition eventually contributed to the breakdown of her marriage before she was referred for specialised treatment.
Today, she encourages other women to seek medical help immediately if they experience similar symptoms.
Teenage pregnancies increase risks
Health experts say teenage pregnancies remain a major driver of obstetric fistula cases.
Uganda’s adolescent pregnancy rate remains among the highest in the region, with nearly one in four girls becoming pregnant before adulthood. Many pregnancies occur among girls aged between 12 and 17 years, when their bodies are not fully developed for childbirth.
Medical experts explain that younger mothers are more vulnerable to prolonged obstructed labour, increasing the risk of fistula and other childbirth complications.
Globally, an estimated two million women are living with obstetric fistula, with between 50,000 and 100,000 new cases reported annually, mostly in low-resource countries.
According to health workers, misconceptions about fistula are compounded by fear and stigma, particularly among teenage mothers.
Ms Abagail Musenero, a registered midwife at Bumonoli Health Centre III, says many pregnant teenagers avoid health facilities because they fear being judged.
“Teen mothers fear health facilities because they think we will judge them,” she says. “Sometimes we have to conduct community outreaches to identify them and encourage them to start antenatal care early.”
She notes that delayed referrals from traditional birth attendants remain a significant challenge.
“We still have many traditional birth attendants conducting deliveries in villages instead of referring mothers early to health facilities. By the time many women arrive here, they have already developed serious complications,” Ms Musenero says.
She adds that some women arrive after many hours of labour with severe bleeding, retained placentas or fistula-conditions that could largely be prevented through skilled birth attendance.
Despite these challenges, Ms Musenero says awareness campaigns are beginning to make a difference, with more women attending antenatal clinics and choosing to deliver in health facilities.
Community education as the solution
Community leaders and health advocates are increasingly focusing on education to tackle both teenage pregnancy and fistula.
Mr Wilberforce Mukone, a male champion working with Naguru Teenage Centre, says stigma remains one of the biggest barriers to healthcare access for pregnant adolescents.
“Many young girls fear going to health facilities because they are ashamed of being questioned about becoming pregnant at a young age,” he says. “That is why many of them opt for traditional birth attendants.”
Through school visits, village meetings, and sensitisation campaigns, community volunteers are educating young people about family planning, early antenatal care, and safe delivery practices.
They also help identify women living with fistula and refer them for treatment whenever repair camps are organised.
Health workers believe sustained community education is the most effective way to dispel myths surrounding fistula and ensure more women seek medical care early.
For survivors like Ms Sanyu, the message is simple but urgent: fistula is not a curse.
“It can happen to anyone during childbirth,” she says. “The important thing is to seek treatment because help is available.”
With support from UNFPA and the Government of Iceland, several fistula repair camps have been organised, successfully treating many young women.
However, survivors say more needs to be done, noting that many teenage mothers living with fistula remain in communities without access to treatment due to stigma, poverty and limited awareness.