Technical Areas
Obstetric Fistula: A Devastating Injury
Obstructed labor remains a leading cause of maternal death and disability, responsible for an estimated eight percent of the approximately half million maternal deaths. Without prompt medical attention and access to Caesarean section services, obstructed and prolonged labor can also lead to still births, neonatal deaths, and maternal disability. Obstetric fistula is one such devastating maternal disability.
During prolonged or obstructed labor, undue, extended pressure in the birth canal can lead to tissue damage. If untreated, this tissue damage results in a fistula — an abnormal opening between a woman’s vagina and bladder or rectum (or both).
An obstetric fistula permits the uncontrollable passage of urine and feces into the vagina, producing a foul odor and often leading to social isolation. Women with fistula usually feel shamed or disgraced. They are sometimes deserted by their husbands and cut off from family, friends, and daily activities. The physical and emotional stress of those suffering from an obstetric fistula is often compounded by the loss of the baby.
Fistula disproportionately affects young and poor women. Women most at risk include:
- Very young women
- Women delivering their first child
- Women whose growth is stunted because of poor nutrition or childhood illness
- Women living in rural areas
- Women who use traditional maternity care and deliver at home
Nevertheless, women of any age or parity may suffer fistula if they have an obstructed labor and do not have access to emergency obstetric care.
The number of women living with obstetric fistula is unknown. New data from DHS surveys show that in Ethiopia, 1 percent of all women who have ever given birth have experienced obstetric fistula, whereas in Malawi the overall prevalence was estimated to be 4.7 percent in 2005. According to the UN, worldwide over 100,000 women were at risk of obstetric fistula each year, and over 2 million women have already been injured and stigmatized. However, these numbers are widely believed to be an underestimate of the true extent of the problem.
Fistula is treatable, but most women in the developing world often lack access to the required medical care and the funds to pay for treatment. Fistula can be surgically repaired but only where trained surgeons and good post-operative care are available. In Africa, there are only two health care centers — one in Addis Ababa and one in Jos, northern Nigeria — that specialize in fistula care beyond the means of most women affected.
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