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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 people are left with 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, but other than HDI, so far mostly on the treatment side.
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 also prevents deaths from obstructed labor, one of the two biggest causes of death during childbirth in many places.
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, and at least three of the subsequent Sustainable Development Goals (1-3).
The cost of adding a catalyst 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 hole, a chronic opening between the vagina and bladder or rectum or both, resulting from a birth that lasted too long, obstructed labor often lasting several days.
- Women with obstetric fistula constantly leak urine and/or intestinal content 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 gave birth many times before.
- These are the survivors, those who did not die of their obstructed labor, though the babies usually 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 childbirth 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 childbirth in these settings.
- The number of affected women seems 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 addressing obstetric fistula have mostly focused on providing surgical repair. That’s perfectly understandable, but prevention is the real solution. Even after 15 years, of strengthening global surgical capacity for obstetric fistula, it is said only 7% of women with fistula are able to access repair.
Obstetric fistula was previously a major problem in all countries. The Waldorf Astoria, a luxurious hotel in New York City, is located on the site of the world’s first obstetric fistula hospital which closed in the early 1900s.
The Cause
When the skull of the unborn child is forced against the woman’s pelvis for several days, in obstructed labor defined as a birth 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, e.g. a week or 10 days, the woman too will die. Obstructed labor can be 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 a blocked childbirth, and if some tissue is no longer viable due to insufficient blood-flow during the days of obstructed labor, then that non-surviving tissue is sloughed off, leaving a hole.
A few days later, depending on whether the hole is on the front wall or the back wall of the vagina, the woman leaks urine or feces or both. The hole and the leakage are permanent unless she receives successful surgery.
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