HOW DOES OBSTETRIC FISTULA HAPPEN?

Recto-vaginal Fistula Formation (RVF)

 

1. What is obstetric fistula?
Obstetric fistula is an injury of childbearing that has been relatively neglected, despite the devastating impact it has on the lives of girls and women. It is usually caused by several days of obstructed labor, without timely medical intervention – typically a Caesarean section – to relieve the pressure.

In as high as 90 percent of fistula cases, the baby will die and the woman is left with chronic incontinence. Fistula sufferers are often abandoned or neglected by their husbands and families and ostracized by their communities. Without treatment, prospects for work and family life for these women are greatly diminished and they are often left to rely on charity.

Vesico-vaginal Fistula Formation (VVF)

 

2. What are the medical consequences of fistula?
Left untreated, fistula can lead to frequent ulcerations and infections, kidney disease and even death. Some women drink as little as possible to avoid leaking and become dehydrated. Damage to the nerves in the legs can leave some women unable to walk. These medical consequences, coupled with social and economic problems, often contribute to a general decline in health and well being that can result in early death.

3. What are the social consequences of fistula?
Beyond these physical consequences, fistula often exacts a severe social toll. The social consequences of fistula include physical and emotional isolation, abandonment or divorce, ridicule and shame, infertility, lack of economic support, and the risk of violence and abuse.

Close-up of Vesico-vaginal formation and resultant fistula

4. Why does fistula occur?
Fistula occurs when emergency obstetric care is not available to women who develop complications during childbirth. This is why women living in remote rural areas with little access to medical care are at risk. Before the medical advances of the 20th century, fistula was quite common in Europe and the United States. Today, fistula is almost unheard of in high-income countries, or in countries where obstetric care is widely available.

Fistula tells us where health systems are failing. The World Health Organization has called fistula “the single most dramatic aftermath of neglected childbirth.” Malnutrition, poor health services, early marriage and gender discrimination are interlinked root causes of obstetric fistula.

Poverty is the main underlying factor, as it is associated with early marriage and malnutrition, and because lack of funds hinders a woman’s access to emergency obstetric care. Consequently, young and poor women living in rural areas are particularly at risk. Because of their low status in many communities, women often lack the power to choose when to start bearing children or where to give birth.

Childbearing before the pelvis is fully developed, as well as malnutrition, small stature and generally poor health, are contributing physiological factors to obstructed labor. Older women who have delivered many children are at risk as well.

5. Can fistula be “cured”?
Yes, fistula is treatable as well as preventable. Reconstructive surgery can mend the injury, and success rates are as high as 90 percent. Two weeks or more of post-operative care is needed to ensure a successful outcome. Counselling and support are also important to address emotional damage and facilitate social reintegration. The average cost of fistula treatment – including surgery, post-operative care and rehabilitation support – is $500.

6. How widespread is fistula?
Fistula is most common in poor communities in sub-Saharan Africa and parts of Asia where access to or use of obstetric care is limited. Good data on fistula are scarce. In 1989, the World Health Organization estimated that more than two million women remain untreated in developing countries and that at least 50,000 to 100,000 new cases occur each year.

But the secrecy and shame that surround the condition make it difficult to get a reliable estimate of its prevalence. Needs assessments done as part of the Campaign to End Fistula suggest those numbers are far too low. In fact, WHO experts have also estimated that in areas of high maternal mortality, two to three women per 1,000 pregnancies develop fistula, which would mean that the prevalence is likely much higher than the 1989 estimates.

7. How can fistula be prevented?
Prevention, rather than treatment, is the key to ending fistula. Making family planning available to all who want to use it would reduce maternal disability and death by at least 20 percent. Complementing that with skilled attendance at all births and emergency obstetric care for those women who develop complications during delivery would make fistula less common. Addressing social issues that contribute to the problem – such as early pregnancy, girls’ education, poverty and women’s empowerment – are important areas of intervention as well.

8. What can I do to help?
One of the most powerful ways you can help is to DONATE to this cause. Most of the maternal deaths and disability due to childbirth can be prevented, and the cycle of poverty that results from women and girls suffering from fistula can be stopped. Resources are the key to providing services and education in the field.

One By One has made it easy to spread the word, do some simple fundraising and be an ambassador. We are constantly developing new ways for people to get involved, so if you are interested or would like to share your particular story or skills with us, email us at info@fightfistula.org.

 

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