Obstetric fistula is a childbirth injury caused by prolonged obstructed labor in which a hole develops between the bladder and vagina and /or rectum and vagina, leading to permanent incontinence.
During a prolonged obstructed labor, the constant pressure of the unborn child's head on the birth canal cuts off the blood supply to the surrounding tissues. After several days of obstructed labor, the affected tissues die off and an opening is created between the bladder and vagina (vesico-vaginal fistula, VVF) and/or rectum and vagina (recto-vaginal fistula, RVF). The result is permanent incontinence, with a woman being unable to control the flow of her urine or feces.
In most cases, the baby dies and the mother is left suffering with severe physical, emotional and social consequences. Due to the constant leaking of urine and feces, she is likely to feel constant pain and discomfort, develop ulcerations in the vaginal tract and easily contract infections. She may become afflicted with a condition known as “foot drop,” making it difficult or impossible to walk because of extreme nerve damage to the lower limbs caused by prolonged squatting during labor. She may also develop kidney disease or even failure due to her limited intake of fluids in effort to minimize the incontinence. Because of her shameful condition, she is likely to be abandoned by her husband, shunned by her family and cast out from her community. She is often left to suffer the loss of her baby, her severe medical condition and her psychological trauma in social isolation.
The World Health organization (WHO) estimates there are 2 million women worldwide suffering from obstetric fistula, with up to 100,000 new cases each year. The majority of these women live in Sub-Saharan Africa, Asia and some Arab regions. They tend to be poor, live in remote areas, have little to no education, are bound to cultural norms and, have no access to medical care. Many are teenage girls whose pelvises are not yet fully developed for childbirth.
While the effects of obstetric fistulas are traumatic, the condition is generally easily treatable and has a 90% healing rate. The cost of one operation is approx USD$ 300. Unfortunately, most affected women do not know about the treatment or cannot afford it.
Obstetric fistula is fully preventable and its incidence can be eliminated if only quality maternal health care services such as family planning, skilled birth attendance, and emergency obstetric care could be made available to all women, particularly those in developing countries. Prevention also entails addressing social issues that contribute to the problem, such as cultural practices (e.g. early marriage and pregnancy), poverty, education and the empowerment of women.
In 2003, UNFPA (United Nations Population Fund) spearheaded the global campaign to End Fistula, a collaborative initiative to prevent fistula and restore the health and dignity of those living with its consequences. In this short time, thanks to partnerships with organizations such as UNICEF, the World Bank, WHO, and funding from high profile humanitarians such as Bill & Melinda Gates, it has succeeded in bringing fistula to the attention of the general public, policy makers, health officials, and affected countries.
While significant progress has been made, ending fistula worldwide still requires more political will, additional resources, and strengthened collaboration between governments, community groups, NGO’s and health professionals.
To learn more about obstetric fistula and how you can help, please visit:
www.unfpa.org
United Nations Population Fund: general information, programs & partnerships.
www.who.org
World Health Organization: principles for clinical management.
www.fistulafoundation.org
The Fistula Foundation: US based non-profit organization founded by former Peace Corps teacher, Richard Haas and daughter Shaleece with the purpose of supporting the work of the Addis Ababa Fistula Hospital in Ethiopia, the foremost medical center in the world devoted exclusively to fistula repair, founded in 1974 by Drs. Reginald and Catherine Hamlin.
www.womenshope.ch
women’s hope international (whi): Swiss based charity founded by Martin & Claudia Leimgruber, husband & wife / doctor & midwife team, dedicated to fistula repair and prevention in Ethiopia, Chad and Afghanistan; also affiliated with Addis Ababa Fistula Hospital.
www.virginunite.org
Richard Branson’s ‘Campaign to End Fistula.’
www.gatesfoundation.org
Bill & Melinda Gates Foundation: maternal, newborn and child health programs.
www.nytimes.com
search: Nicholas D. Kristof / obstetric fistula.
Recommended reading:
‘Hospital by the River’ by Dr. Catherine Hamlin.
Report submitted December 14,2009
by Sara von Moos, UN NGO rep