Where we currently stand on obstetric fistula treatment and prevention

Abstract

Over the last two decades, obstetric fistula has rightly gained some prominence as a public health issue. It has been a rocky road, with each step along the path bringing positives and negatives: one step forward, two steps back. Thankfully the end result has been overwhelmingly positive.The increased awareness of obstetric fistula first led to an increase in the availability of funds to help women with the condition, which in turn led to more people performing fistula surgery. All good. However, a small group of people took, and still take, advantage of the funds and perform surgery without adequate training, leading to unnecessary breakdowns and complications, which ultimately increases the suffering of these women, rather than decreases it. In response, FIGO (the International Federation of Gynecology and Obstetrics) founded a standardized global fistula training program that enables many surgeons to be trained in the latest techniques and thousands of women with obstetric fistula to access quality surgery.The surgical community has looked more closely at the outcomes of fistula repair and exciting new techniques have been developed to improve continence rates with a closed fistula and ways to improve sexual health. Twenty years ago, ongoing incontinence rates despite fistula closure were often overlooked and categorized as too difficult to rectify. We are now getting many more of these most severely injured women fully continent thanks to some exciting developments, but there is still much room for improvement. Likewise, novel techniques of vaginal reconstruction have also enabled women to resume a sexual life.The Millennium Development Goals sought to decrease maternal death and disability. Although we've seen a two-thirds reduction in maternal deaths in Africa and Southeast Asia-the areas where obstetric fistulae occur in greatest numbers-more needs to be done. We hope that the Sustainable Development Goals will continue to make improvements to maternal health and indirectly to obstetric fistula.In December 2018, the UN General Assembly made a call to end fistula by 2030, eliminating obstetric fistula within a decade. Soon after the announcement an initial planning meeting was held with members of the International Society of Obstetric Fistula Surgeons (ISOFS) and the plans to achieve this continue to evolve. This is indeed a noble and ambitious task and we hope that it will propel positive action; however, action needs to be directed. All too often we have seen wealthy donors wanting to help by giving expensive equipment that has wasted millions of dollars investing in high-tech ideas when the problems and solutions are far more basic. The overwhelming and daily frustrations such as having water, gloves, medicines, and sutures available in hospitals, and educating communities on women delivering in a hospital, either at no cost or greatly subsidized, need to be funded first. These basics are what eradicated fistula from highresource countries over 100 years ago, not expensive, complicated systems and techn...

Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement

“…Also, though prevention is key, treating those that already have fistula remains of great importance especially considering the enormous impact of OF on the affected women. Fortunately, after the launch of the global campaign to end fistula in 2003, much progress has been made in improving the treatment of OF patients, but the best strategy for OF prevention still remains a difficult topic [66][67][68][69].…”

IJGO: Continuing to advance women’s health research and practice globally

“…One of IJGO’s key aims is to help achieve improvements in the reproductive health status of women globally, and as part of this agenda we aim to disseminate as widely as possible key guidance and successful initiatives from FIGO’s expert committees and working groups. Among recent notable publications are the FIGO Initiative on Pre‐eclampsia guidance 10 ; a supplement on the important work carried out by our Fistula project, 11 and a special section from FIGO’s Preterm Birth Working Group 12 . Over the next 6 months we look forward to expert guidance papers from our Safe Motherhood and Newborn Health Committee, and FIGO’s Pregnancy Obesity and Nutrition Initiative.…”

The Silent Suffering: Obstetric Fistula in Ethiopia

“…Surgery has had a profound effect on women living with obstetric fistula. However, areas with the highest incidence are least likely to have qualified medical professionals to treat the condition (Browning & Syed, 2020). This analysis will focus on Ethiopia, located in the Horn of Africa.…”

“…Over half of women with obstetric fistula may develop urinary tract infections (Dereje et al, 2017). Despite the condition being preventable and treatable with surgery, there is still a high prevalence in low-income countries (Browning & Syed, 2020). Although the incidences of obstetric fistula are difficult to document due to the lack of medical reporting, this analysis will focus on the effects of the disease in Ethiopia, one of the poorest countries in the world (The World Bank, n.d.).…”