International Day to End Obstetric Fistula

The preventable tragedy 

Obstetric fistula is one of the most serious and tragic injuries that can occur during childbirth, affecting 2-3 million women in developing countries. 50,000-100,000 new cases of obstetric fistula occur yearly.

However, 80-95% of vaginal fistula can be closed surgically; there is hope for women with obstetric fistula. It is therefore very crucial to make people informed about this condition as it leaves many women broken emotionally and unable to continue with their normal lives.

What is Obstetric Fistula?

Obstetric fistula is a medical condition that occurs when a hole is formed between the birth canal or genital tract and the urinary tract; that is the bladder or rectum, due to prolonged obstructed labour, without prompt treatment such as caesarean section.

Prolonged labour is labour that lasts for 2 or more days while obstructed labour refers to when the baby, during birth, is unable to progress to the birth canal even with strong uterine contractions. Obstetric fistula leads to incontinent or uncontrollable passing of urine and/or faeces as well as other health issues.

What brings about this condition?

Obstetric fistula occurs due to prolonged and obstructed labour, but what causes this? The factors that increase the risk of a woman experiencing obstetric fistula are:

  • Early marriage which is a major issue in the regions that have high obstetric fistula cases especially developing nations,
  • Lack of access to skilled obstetric and emergency care that makes it difficult for women who experience complications during labour to get the urgent medical assistance they require, and
  • Untimely access to the right obstetric care because most of the regions that experience high cases of obstetric fistula have poor infrastructure and therefore, during labour most women are unable to get to health facilities in good time to give birth safely. In very remote areas, some of the health facilities do not even have the equipment required to help women who go through obstructed labour.

This is why there is great need to ensure that more people are educated about this condition because only then, will we understand how to prevent it and in the long run, end it.

Ending obstetric fistula

The positive side of this issue is that obstetric fistula is preventable, but only if there is:

  • Education: The first step to ending obstetric fistula is educating the society on:

1. the importance of making sure that pregnant women get good medical care by getting regular maternal clinic sessions throughout their pregnancy,
2. making sure that women give birth in health facilities and not at home, and
3. the importance of embracing women who have obstetric fistula.

  • Ensuring skilled obstetric care: Those responsible for providing health facilities, for instance governments, should ensure that all pregnant women are able to access skilled birth attendance so as to deliver safely and have emergency care such as caesarean section available, in case of obstructed labour.
  • Timely obstetric care: Pregnant women should get to hospitals in time and to make that possible, there should be good infrastructure; good roads, and good standard hospitals that have the necessary equipment in all areas so that women do not have to travel for long distances to seek medical care during labour.
  • Ending early marriages: In most developing countries, young girls are forced into early marriages which increases their risk of labour complications. This practice should be stopped to reduce obstetric fistula cases in young girls by delaying their first pregnancy.

What to do for women with obstetric fistula

Women living with obstetric fistula, in most cases, experience social isolation when they are shunned away by their communities or even by their families which can lead to depression and in turn, poverty as most of them are unable to live their normal lives and get income.

Accepting women that live with this condition goes a long way into helping them gain their self-worth and move on with their lives. However, moving on with life completely, might be difficult for them because of the constant leakage of urine, faeces, or both. Therefore, getting such women to get treatment for the condition is the best step to take in giving them their lives back.

  1. Surgery is the most used treatment for this condition, as 80-95% of fistula cases can be corrected through simple reconstructive surgery.

If the patient cannot afford the cost of reconstructive surgery, the following treatments can be used:

  • Urostomy: This involves diverting the flow of urine from the kidneys and ureters, surgically, to allow the urine to be collected into a bag, thereby avoiding leakage.
  • Catheterization: It involves inserting a Foley catheter into a woman’s urethra where the urine is drained from the bladder into a bag that can be drained when full. This procedure is ideal when the condition is in the early stage because there are higher chances of the hole closing naturally if it is small.

Let us all contribute towards ending obstetric fistula by sharing this information with as many people as possible because making people informed is the best way to make this goal a success. Obstetric fistula is preventable and we all can have a role to play in ending it.

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Treating conditions in their early stages is less costly and more likely to be successful.

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