ABOUT FISTULA What is Fistula?

Whats is Fistula
What is Obstetric Fistula?

What is Obstetric

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.

50,000 women and girls develop obstetric fistula annually.

develops it?

The short answer is: The poorest and most marginalized women and girls, especially those who live far from health care services and those who cannot access or afford them – the same group most at risk of dying in childbirth.

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.

An estimated 500,000 women and girls in the developing world live with obstetric fistula today.

500,000 women and girls

causes it?

Prolonged, obstructed labour – when the baby becomes stuck inside a woman’s body, unable to come out through the birth canal.

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.

What causes it?

90% of women who develop obstetric fistula deliver a stillborn baby.

90% of women who develop

How are
women and
girls affected
by fistula?

Their lives are essentially shattered, defined by lifelong physical and emotional trauma.

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.

The average cost of fistula treatment is around $600, well beyond the reach of most women with the condition.

Cost Treatment

How can
fistula be

Skilled birth care during deliveries and timely access to quality emergency obstetric care when complications arise. Ending poverty and inequalities.

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
Family Planning

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 Attendance Planning
Skilled birth attendants

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.

Emergency Obstetric Care
Emergency obstetric newborn 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.