Crib Sheet: Obstetric Fistula

Wrought by poor public health, this condition is preventable- and you can help.

By Genna Beier, Pomona College

Fistula tells us where health systems are failing.
—Mary Nell Wagner, EngenderHealth

The incidence of obstetric fistula is a tremendous indicator of global health inequality. The treatable condition has been nearly wiped out in the developed world and yet there are tens of thousands of cases in sub-Saharan Africa annually. And so, unsurprisingly it is largely a neglected cause in the developing world, despite its devastating impact on the women that it affects.

Obstetric fistula is a childbirth injury that occurs when the baby’s head becomes lodged in the birth canal during an obstructed labor, creating a hole between the vagina and the bladder and/or rectum. Fistula can also be caused by violent rape. For example, in 2003 there were thousands of cases of traumatic fistula caused by violent gang rape during the Congo’s five years of civil war. The physical and social consequences of fistula are life-shattering. In the majority of cases, the baby is stillborn. The fistula causes the mother to become chronically incontinent, meaning that she will leak urine and/or feces uncontrollably for the rest of her life. Because of the perpetual smell and leakage associated with her condition, the woman is often considered “unclean” and left isolated and marginalized from her family and community. In many cases, her husband abandons her. After being exiled from their communities, these women are forced to live without financial or social support. As if enduring the pain of obstructed labor wasn’t enough, they are deprived of their child, their health, their means of survival, and their dignity.

Who does it affect?

Because of the shame surrounding fistula and the socioeconomic and geographic barriers to receiving medical attention, it is difficult to accurately assess its prevalence. A study done by the World Health Organization estimates that for over two million (PDF) women in the developing world this devastating condition persists. Each year there are 50,000 to 100,000 new cases of fistula. The women afflicted by fistula are overwhelmingly the poor, stigmatized, and powerless members of rural communities. These primarily young women are from sub-Saharan Africa and South Asia and lack education and access to medical care.

For those of us in industrialized nations who are fortunate enough to have access to quality obstetric care, fistula is extremely rare. Not only is it easily preventable by a Caesarian section, it is also treatable in over 90% of cases with a fairly simple fistula repair operation costing approximately $300. But in the rural areas where fistula is most common, access to adequate maternal care is severely limited and few hospitals offer the necessary corrective surgery. In Niger, a country of over 12 million where fistula is exceptionally common, there are only six surgeons (PDF) with the technical expertise to perform fistula repair surgeries.

What is being done to end fistula?

Despite the large number of women it affects, obstetric fistula is a largely neglected reproductive health concern in the global health community. But several governmental and non-governmental programs have spearheaded the prevention and treatment of fistula. These programs focus on providing access to family planning services and emergency obstetric care as well as examining the important socio-cultural factors that contribute to fistula, such as malnutrition, early marriage, female genital cutting, and gender discrimination. In order to be successful in the fight against fistula, groups such as EngenderHealth and the Campaign to End Fistula need to focus on providing training to more fistula repair providers in more locations, creating community awareness campaigns, organizing better transportation to health care sites, and rehabilitating women with fistula so that they can be reintegrated into society with the skills to be economically self-sufficient.

How does U.S. politics affect funding for programs that address obstetric fistula?

Every year since 2002, the Bush administration has decided to withhold the $34 million that congress allocates annually for the United Nations Population Fund (UNFPA). The UNFPA is a world leader in the field of international family planning and a major contributor to fistula prevention and treatment programs. One hundred sixty-six nations fund the UNFPA’s work to eradicate fistula in 35 countries. The United States is the only Western developed nation that does not fund the UNFPA. Instead, those funds go to the U.S. Agency for International Development (USAID), which is a far less comprehensive program that operates in fewer countries. Bush’s decision not to provide funding is based on the false claims that the UNFPA supports forced abortions in China, despite a report from his own fact-finding mission that found otherwise. He now continues to deny funds on the grounds that, just by working there, UNFPA supports China’s highly coercive family-planning policies. When Bush cuts the UNFPA budget as part of his conservative opposition to family planning, women pay the price. The UNFPA estimates that the $34 million withheld every year by President Bush would be enough to prevent two million unwanted pregnancies, eliminate 800,000 induced abortions, 4,700 maternal deaths, nearly 60,000 cases of serious maternal illness (such as obstetric fistula), and over 77,000 infant and child deaths.

How is fistula connected with other global health issues?

Obstetric fistula is just one example of the discrepancy between the health care provided in rich and poor nations. Allowing poor, rural, and uneducated women timely access to obstetric care will help to bridge this gap. The high incidence of fistula in the developing world underscores the health benefits of enabling women to control their fertility and plan the spacing and timing of their children. When women are educated (PDF), they are more likely to get married later and to be physically ready when they become mothers. The lack of attention afforded to obstetric fistula is symptomatic of the way in which the rights and health of the most powerless and marginalized members of society are not being effectively safeguarded. This is compounded by the way that funding allocation for reproductive health issues, such as fistula, has become entrenched in the politics of abortion and contraception.

How can you help in the fight against fistula?

It is our duty to raise awareness about fistula and combat this unconscionable neglect. There are many ways to help eradicate fistula and restore dignity to the lives of women who suffer from it.

1.) Learn: Obstetric fistula is a condition that should no longer exist in the 21 st century. Modern medicine has identified the causes of fistula and has provided effective means for its prevention and treatment. Educate yourself about this preventable condition and its harmful effects.

2.) Donate: Every contribution makes a difference. For example, $5 covers the weekly costs of food and water for a recovering patient, $10 covers transportation to a hospital, and $80 covers the surgical instruments needed for fistula surgery.

3). Act: Work to make essential reproductive health services available to women in the developing world. Educate others about the condition. Most people do not know that this devastating condition exists. Hold a screening of the documentary LoveLaborLoss, which tells the tragic story of the women living with fistula and what can be done to help them. Write an article in your school or local newspaper, call in to your local radio station, or organize a fundraising event in your community. Your efforts can help restore the health and dignity to these women in need.

 
Genna Beier is a junior at Pomona College and an intern for Domestic Policy at the Center for American Progress.

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