Obstetric Fistula: A Preventable Tragedy

Abstract

Obstetric fistula disables millions of women and girls in developing countries, primarily in sub-Saharan Africa and South Asia. The United Nations Population Fund (UNFPA) recently launched a global campaign to end fistula, labeling this condition a preventable and treatable tragedy. Obstetric fistula overwhelmingly results from obstructed labor, which occurs in cases of cephalopelvic disproportion and malpresentation. Cephalopelvic disproportion often complicates deliveries in young, primiparous women of low gynecologic age. Social factors, including young age at marriage and malnutrition of girl children, can also contribute to cephalopelvic disproportion. These social etiologies must be addressed by prevention campaigns. Direct prevention of fistula can occur during delivery when skilled providers identify women and girls at risk for obstetric fistula and link them with innovative interventions, such as Fistula Prevention Centers, through which they can more readily access emergency obstetric care, and by setting strict time limits for laboring at home without progress. Community-based programs, such as the Tostan program in West Africa, use social education to prevent fistula. Moreover, effective surgical techniques for fistula repair are available in some settings and should be expanded to reach those in need. Midwives can play a key role in the prevention and treatment of this tragic obstetric complication.

High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward?

“…More rarely, the injury can be caused by genital cutting, poorly performed abortions or pelvic fractures. 2 The condition has been eradicated in the industrialised world, but remains a common complication of childbirth in developing countries, affecting about three million women worldwide. 3 In Burundi, the incidence of obstetric fi stula is estimated at 0.2-0.5% of all deliveries.…”

Health‐related quality of life among women in rural Bangladesh after surgical repair of obstetric fistula

“…Nevertheless, many women still remain unaware of treatment possibilities [9]. Among those who have undergone surgical repair, health-related quality of life (QOL) is a key issue; however, most studies conducted to date have focused on QOL before rather than after surgery [4,5,7].…”

Female urinary incontinence: a systematic overview and non-surgical treatment

“…42 Estimates indicate that 2-3 millions women live with obstetric fistulae worldwide, the majority of whom are in Africa and Asia. [43][44][45] Fistulas are preventable and treatable, however, many women are still unaware of the availability of treatment and 80% of them never seek treatment due to lack of knowledge. 43 Moreover, women suffering from this condition are initially kept hidden; subsequently, they find it difficult to maintain decent standards of personal hygiene because water for washing is generally scarce; divorce becomes inevitable and destitution follows, these women being forced to beg for their livelihood.…”

“…[43][44][45] Fistulas are preventable and treatable, however, many women are still unaware of the availability of treatment and 80% of them never seek treatment due to lack of knowledge. 43 Moreover, women suffering from this condition are initially kept hidden; subsequently, they find it difficult to maintain decent standards of personal hygiene because water for washing is generally scarce; divorce becomes inevitable and destitution follows, these women being forced to beg for their livelihood. 46 Despite much debate, there is no universally accepted system for classifying fistulae, and a wide variety of different systems have been proposed [ 47 Classification of fistulas is important only to the extent that the classification has a meaningful relationship to the prognosis of the injury.…”