Taking action means saying “no” to indifference… it is a choice: whether or not to support a woman, whether or not to protect her, whether or not to defend her rights.
– Dr. Denis Mukwege, 2018 Nobel Peace Prize winner and fistula surgeon.
May 23 is the International Day to End Obstetric Fistula, a UN observance day that was started in 2013. The purpose of the day is to raise awareness and mobilize global support regarding the issue.
What is a fistula?
It is an abnormal opening between the vagina, bladder and/or rectum, most often caused by obstetric labor. Approximately 50,000–100,000 women are affected by obstetric fistulas on an annual basis, and more than 2 million young women live with untreated obstetric fistulas in Asia and sub-Saharan Africa. Fistula repair surgery was a fairly general practice in Western countries in the late 1800s, often performed in dedicated fistula hospitals. The last of these hospitals was closed just before 1900.
Obstetric fistulas not only result in significant medical consequences, but can also be devastating for women from a psychological, social and economic perspective. Unable to control the constant leaking of urine, there also could be a foul-smelling vaginal discharge or passage of stool from the vagina, as well as the possibility of recurring infections and chronic pain. The smell of urine and feces can drive family and friends away, resulting in the woman losing her social status and protection from her family.
For every woman treated, 50 more go without treatment.
Obstetric fistula as an entity is not specifically addressed in the SDGs, but is addressed in SDG3 which addresses the improvement of maternal health:
- Indicator 3.1.1: The maternal mortality ratio refers to the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births.
- Indicator 3.1.2: Percentage of births attended by personnel trained to give the necessary supervision, care, and advice to women during pregnancy, labor, and the postpartum period; to conduct deliveries on their own; and to care for newborns.
It is important to add that fistulae can also occur unrelated to labor. Iatrogenic fistula occurs when the bladder is accidentally cut during a cesarean section, but can also occur during surgery unrelated to childbirth. In rare cases, radiation of the pelvic area can also result in a fistula. Traumatic fistula can also happen as a result of sexual violence, either as a result of the rape itself or as a result of pushing objects into the vagina.
Obstetric fistula can be prevented (and this information needs attention and frequent repetition!) by several actions, namely:
- delaying the age of first pregnancy;
- the cessation of harmful traditional practices;
- timely access to obstetric care.
How can a fistula be treated?
A holistic approach is required, including the factors mentioned previously. Good maternal health care, access to family planning, skilled care at birth, basic and comprehensive emergency obstetric care, and then, of course, affordable surgical treatment of fistula are all important aspects in the treatment. Counselling is an important aspect of the recovery process. Approximately 80–95% of vaginal fistulas can be closed surgically with the repair of the hole between the vagina and bladder.
There are a number of organizations that are working on fistula repair, including USAID through the Fistula Care Plus program.
Sources:
https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula