Obstetric Fistula: A Silent Killer Among Women and Girls

May 24, 2017

By Naledi Katsande

Hivos joins the rest of the world in commemorating International Day to End Obstetric Fistula, commemorated annually on 23 May 2017. Obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labor in the absence of timely and adequate medical care, leaving a woman incontinent (lacking voluntary control) of urine or faeces or both.

Obstetric fistula is one of the most serious and tragic child birth injuries, contributing to 6 per cent of all maternal deaths worldwide and 50 000 to 100 000 injuries globally. More than 2 million women in Asia and Sub-Saharan Africa live with untreated Obstetric Fistula yet 80 per cent to 95 per cent of cases can be treated.

Women with obstetric fistula are often rejected by husbands and the societies they live in because of the foul smell produced by the ‘leaking’ urine/ faeces. As a result of social isolation, these women and girls may eventually suffer from depression. In addition, without treatment, fistulae can result in complications such as repeated vaginal or urinary tract infections as well as chronic pain.

Obstetric Fistula is highly prevalent in poor communities where women have limited access to emergency obstetric care. For women with obstructed labor, labor that goes unattended, the labor can last up to six or seven days. The labor produces contractions that push the baby’s head against the mother’s pelvic bone. The pressure of the fetal head on the vaginal wall causes tissue necrosis (tissue death), due to a decrease in blood flow to the area, causing a fistula to develop between the vagina and the bladder or rectum. This is what produces incontinence in a fistula patient.

Research has also linked the following factors to obstetric fistula:

Child pregnancy associated with child marriage where the girl’s pelvis is too small for passage of the baby has been linked to obstructed labour. Malnutrition which is usually associated with poverty (where families cannot afford to eat nutritious foods) and gender discrimination (where nutritious foods are limited to the father and the boy children in a family) often limit the growth of pelvises of most women and girls causing obstructed labour which often leads to fistulae. Severe forms of female genital cutting involving pricking, piercing and scraping have been associated with the development of Obstetric Fistulae.

Patients with uncomplicated obstetric fistula can undergo simple fistula corrective surgery, restoring hope, health and a sense of dignity not only to the women, but also to their loved ones. However, in developing countries, poverty remains a barrier to accessing treatment services as many women and girls cannot afford the high cost of service, hence they continue to suffer in silence. In Zimbabwe as of 2017, over 500 women are on the waiting list to undergo corrective surgery. This large number reflects the magnitude of the challenge.

The following are some of the key recommendations that can be used to reduce incidence and prevalence of obstetric fistula:

Developing personal skills is essential in facilitating women to identify red flags and seek treatment before complications arise

Research is needed in order to document numbers of women and girls affected by this condition in order to facilitate evidence based planning. Sub- Saharan Africa in particular has very little data on existing conditions.

Creating a supportive environment for women and girls suffering from Obstetric Fistula through sensitization of communities on the condition will greatly reduce social isolation, thereby reducing incidence of depression. In addition, training of healthcare providers in emergency obstetric care and making available the equipment for deliveries and corrective surgery, transport and communication systems for referrals complete the package of essentials required to end Obstetric Fistula