Obstetric Fistula

Major Support Provided By

Izumi Foundation KavliFondet Norad Provictimis

Summary

Obstetric fistula is an injury that results from obstructed childbirth, most commonly in girls and young women whose bodies are physically not mature enough for healthy birthing.  As a result of this injury, which occurs almost exclusively in areas of poor countries in Africa and Asia where caesarian section is not available, these girls are left with a devastating condition that causes permanent leakage of urine and/or feces unless surgery corrects it.

An estimated 2 million women have fistula and must live with its consequences, while an additional 50,000 – 100,000 girls and women get obstetric fistula each year. A number of UN-agencies, governments and non-governmental organizations (NGOs) have taken up the challenge.

Recent observations suggest that adopting catalyst approaches from successful disease eradication programs would make efforts to eliminate obstetric fistula much more effective, though fistula is not biologically eradicable. Preventing fistula will of necessity also prevent deaths from one of the two biggest causes of death during childbirth. Preventing and treating fistula is an effective way to deal with a guarantor of major poverty and addresses six of the eight UN Millennium Development Goals, numbers 1,3,4,5,6, and 8.

The cost of adding a catlyst approach onto existing fistula elimination efforts is well within reach if a few donor-countries and foundations join together, a pittance compared with the number of women to be protected, the poverty averted, and the amount of denigration prevented.

The Problem

Obstetric fistula is a chronic opening between the vagina and bladder or the vagina and rectum, or both, resulting from a blocked birth (obstructed labor) that lasted several days.

  • Women with the condition constantly leak urine and/or feces through their vagina.
  • Women with obstetric fistula are often forcibly divorced, ostracized, or worse.
  • The risk of getting fistula is highest in girls who get married in childhood and pregnant in their early teens, and for women who have given birth many times before.
  • These are the survivors, those who did not die of their obstructed labor, though the babies often do.
  • WHO estimates about 2 million women living with the condition today; 50,000-100,000 new women each year; and 500,000-750,000 women dying during child-birth every year, the equivalent of a fully-packed jumbo-jet crashing every 4 hours, with obstructed labor being one of the two main causes of death during child-birth.
  • The number of affected women seems to be highest in central Asia and south Asia, while the rate of new cases seems to be highest in Africa, perhaps especially in areas near and in the Sahara desert. Nobody yet knows the exact extent of the problem.
  • Agencies that address the issue have often focused on making surgical repair available. That’s very understandable, but prevention is also crucial.

Obstetric fistula was previously a major problem in all countries of the world. The Waldorf Astoria, a luxurious hotel in New York, is on the site of the world’s first fistula hospital, which closed in the early 1900s when fistula was eliminated from New York.

The Cause

When the skull of the unborn child is forced against the woman’s pelvis for several days, in obstructed labor defined as labor lasting more than 24 hours, some of the soft, delicate tissue of the vagina can die for lack of oxygen and blood-supply.

If labor lasts long enough, the woman too will die, as a birth in Afghanistan that lasted 10 days illustrates. Obstructed labor is the main cause of mothers dying while giving birth in many remote areas (while bleeding is often the main cause elsewhere).

If the woman survives the birthing process, and if some tissue between her vagina and the surrounding locations is no longer viable due to insufficient blood-flow during several days of obstructed labor, then that non-surviving tissue is sloughed off. The result is a hole.

A few days after the birth, depending on whether the hole is on the front wall or the back wall of the vagina or both, the woman leaks urine or feces or both, through her vagina. The hole and the leakage are permanent unless she has successful surgery.