A devastating childbirth injury, obstetric fistula is a hole between the birth canal and bladder (called vesicovaginal fistula) and/or rectum (rectovaginal fistula) resulting in uncontrollable leaking of urine and/or faeces.
While any woman can develop fistula, young women, adolescent or pre-adolescent girls whose bodies are not fully developed for childbearing are particularly vulnerable, which is why ending child marriage can help in the fight to end fistula. Multiple pregnancy, a baby’s breech position, malnutrition, small stature and poor health conditions also can contribute to obstructed labour.
An estimated five hundred thousand women and girls in more than 55 countries throughout sub-Saharan Africa, Asia and the Pacific, the Arab States and Latin America and the Caribbean are estimated to be living with fistula, with approximately 50,000 new cases every year.
This is why rich settings where such treatment, namely Caesarean section, and emergency obstetric care are available have all but eliminated fistula.
Without urgent, high-quality medical assistance, such a difficult labour can last for days, with the constant pressure of the baby’s head cutting off blood supply in the pelvis and leaving a hole after the dead tissue falls away, resulting in fistula or worse, possibly death. Obstructed labour is one of the leading causes of maternal death worldwide, and 90 per cent of fistula cases end in stillbirth.
Some female genital fistulas are caused during gynaecological procedures (e.g. hysterectomy) and Caesarean-sections with substandard health care and inadequate surgical skills training/competence. These are called iatrogenic fistulas. Traumatic fistulas are caused by sexual violence, especially in conflict areas; the destruction of the vagina is considered a war injury.
On a deeper level, fistula implies a failure of health systems to meet the needs of the most disadvantaged women and girls, as well as social injustice and gender and socioeconomic inequality, lack of education - all hinder the empowerment of women and girls and their right to bodily autonomy.
As a preventable condition that still afflicts half a million women and girls, it is a violation of human rights and a tragic example of gross inequities reflecting the marginalization of those affected.
They can suffer incontinence, which can lead to infections, ulcerations, kidney disease, painful sores and infertility. Nerve damage in the legs can restrict mobility.
Because of the smell from constant leakage, they are often shamed and stigmatized, abandoned by their families, ostracized by their communities, suffering depression and suicidal thoughts in their isolation.
Denied work opportunities, they are driven deeper into poverty and vulnerability. No one should ever have to live this way.
Securing human rights, education and economic opportunity for all women and girls. Ending child marriage and early childbearing. Universal access to health care, including sexual and reproductive health and modern contraception.
Fistulas can often be repaired, but women and girls with the condition may not know about or can’t access or afford the reconstructive surgery that would transform their lives and restore their dignity. In the poorest settings and/or humanitarian/emergency contexts, a lack of highly skilled, competent surgeons able to handle complex cases of fistula puts many women at risk of dying before being treated.
Fistula is generally treatable, yes, but more crucially, it is preventable. If industrialized nations have managed to virtually end fistula, it can be done elsewhere. And it should. This doesn’t have to happen ever again. And it shouldn’t.
Family planning saves lives. Contraceptives prevent unintended pregnancies, lowering the incidence of death and disability related to child-birthing complications like obstetric fistula.
Skilled birth attendants, such as midwives, could help avert roughly two-thirds of all maternal and newborn deaths. A well-trained midwife can provide life-saving antenatal, delivery and post-natal care.
When childbirth goes wrong, emergency obstetric care is critical to reducing maternal mortality. In case of complications (like obstructed labour) rapid access to well-functioning emergency obstetric facilities that meet good quality-of-care standards can be the difference between life and death.
