Women's Fistula Repaired as Surgeons Trained

Fistula is a medical condition caused by prolonged labor during childbirth or rape, leaving thousands of women, primarily in Africa and Asia, living in isolation and shame and often destitute.

Although treatable, few doctors are trained to perform repair surgeries. And because women are shunned by their communities, little is done to help them survive.

To help these women, USAID is spending $800,000 to train doctors in fistula-repair surgery. These programs, offered through the Bureau for Global Health and the Uganda and Bangladesh missions, also support education to communities to prevent fistula and counseling to help women who have undergone surgery reintegrate into their communities.

Childbirth and pregnancy complications are a leading cause of death and disability among women in developing countries. Obstetric fistula alone affects at least 2 million women worldwide, according to the World Health Organization.

Obstetric fistula is an abnormal opening caused by tissue damage between the vagina and the bladder or rectum. A timely Caesarean section can prevent the condition, but in poor countries births are rarely attended by skilled personnel.

Surgery can repair fistula, but few doctors in Asia and Africa are trained to perform such operations, and often women have to travel long distances to reach hospitals where such work is done.

Women who suffer from fistula leak urine and feces. Some suffer neurological damage that can affect their ability to walk. Many feel shamed or disgraced and are deserted by their husbands and families.

Through the new program, USAID will help train doctors to treat fistula at two hospitals in Bangladesh and three in Uganda. Two more Ugandan hospitals are expected to join the program as it expands.

Hospitals will link patients with support services such as counseling. The program also will help reintegrate women into society and teach families about the signs of fistula and the importance of safe childbirth.

In Uganda, the program will also support an awareness campaign targeting men, so that they learn about the importance of safe childbirth.

In Bangladesh, the government and the private sector will be asked to pay for patients to travel to hospitals.In Ethiopia, where homebirth is the norm, USAID programs support community education teaching families to recognize childbirth complications, so that women are taken to health facilities in time to prevent fistula.

Although fistula most often results from difficult labor in childbirth, a growing number of women in wartorn regions such as eastern Congo acquire fistula through rape.

The Bureau for Global Health hopes to extend its new program to a hospital in the Democratic Republic of Congo, but not until an assessment of the physical and emotional needs of populations affected by violence is undertaken in eastern Congo.

Read the July/August 2004 Issue of FrontLines [PDF, 1.6MB]