Obstetric fistula is a devastating pregnancy related disability and affects an estimated
200,000–500,000 women each year. While fistula is a global problem, it appears to be
particularly common in Africa and developing countries globally due to poor health
facilities. Fistula is a condition that often develops during obstructed labour, when a
woman cannot get a Caesarean section (C-Section). Obstruction can occur due to
malnutrition and pregnancy at a young age (which both lead to small pelvis width, and
thus pronounced Cephalo-pelvic disproportion). The woman can be in labour for five
days or more without medical help, although obstructed labour for even a single day
can yield damaging outcomes. If the obstruction is not interrupted in a timely manner,
the prolonged pressure of the baby’s head against the mother’s pelvis cuts off the blood
supply to the soft tissues surrounding her bladder, rectum and vagina, leading to tissue
necrosis. The baby usually dies, and fistula is the result. If the fistula is between the
woman’s vagina and bladder (Vesico-Vaginal Fistula) VVF, she has continuous leakage
of urine; and if it is between her vagina and rectum (Recto-Vaginal Fistula) RVF, she
loses control of her bowel movement. In most cases, permanent incontinence ensues
until the fistula can be surgically repaired. In addition, most women are either unaware
that treatment is available, or cannot access or afford it.
Unable to stay dry, many women live with the constant and humiliating smell of urine
and/or feces. Nerve damage to the legs can also make it difficult to walk. Affected
women are often rejected by their husband/partner, shunned by their community and
blamed for their condition. Women who remain untreated may not only face a life of
shame and isolation, but may also face a slow, premature death from infection and
kidney failure. Because of their poverty and their lack of political status, not to mention
the stigma that their condition causes, these women have remained largely invisible to
policy makers both in society and out of their communities.
PREVENTING THE TRAGEDY OF OBSTETRIC FISTULA
Obstetric fistula is a preventable and treatable condition that no woman should have
to endure. Direct causes of fistula include childbearing at too early an age, cultural
practices like FGM and limited access to emergency obstetric care facilities. Some of
the indirect causes, such as poverty and lack of education, prevent women from
accessing services that could preclude the onset of such conditions. Prevalence is
highest in impoverished communities in Africa.
The World Health Organization estimates that over two million women are currently
living with obstetric fistulas. Estimates are based on the number of people who seek
treatment in hospitals and clinics and are, therefore, likely to be much too low as many
women never seek care due to stigmatization and poverty.
Fortunately, most fistulas can be repaired surgically, even if they are several years old.
The cost ranges from $100–$400 USD, but this amount is far beyond what most patients
can afford. If done properly, the success rate for surgical repair is as high as 98% and
women can usually continue to bear children. Attentive post-operative care, for a
minimum of (10-14 days), is critical to prevent infection, catheter blockage and
breakdown of the repair site while the surgery heals. Education and counselling are also
needed to help restore the woman’s self-esteem and allow her to reintegrate into her
community once she is healed.