International Day to End Obstetric Fistula
Created by Ambili S Kartha Updated on May 23, 2018
May 23 is the United Nations’ (UN) International Day to End Obstetric Fistula. This campaign encourages and takes necessary measures to treat and prevent obstetric fistula, a condition that affects 2 to 3 million women and girls in developing countries especially Asia, Africa, Latin America and the Arab region. You will understand the significance of an Obstetric Fistula day only if you understand the consequences and impact of this serious and tragic injury, that happens during the childbirth, to the mother. And, most importantly, Obstetric fistula is almost entirely preventable. Continue reading to know more about this condition.
What Is The Fistula?
Fistula refers to a connection or passage develops between two hollow or tubular organs or a hollow or tubular organ and the body surface that are not normally joined together. Fistulas can appear in the digestive, urinary and reproductive tracts, and even in the circulatory system. Fistulas can develop in the body by birth or because of disease, infection, surgery, or injury. As we all know women are subjected to different kinds of injuries in the course of childbirth. While some are inconsequential, some are very serious and even tragic. Obstetric Fistula belongs to the second group.
What Is Obstetric Fistula?
An obstetric fistula is a hole between the vagina and rectum or urinary bladder that is formed mainly as a result of prolonged obstructed labor. This will leave a woman to suffer constant incontinence of urine or feces or both, paving ways to humiliate, social segregation and several health problems.
How Does Obstetric Fistula Occur?
During unassisted prolonged labor, or when a woman isn’t able to access a C-section when she needs, prolonged uterine contractions can compress the maternal tissue against hard bone on either side of it (one side mother’s pelvis and infant’s head on other). These sustained pressure of the baby’s head damages and kill the soft tissues and obstruct the blood flow towards the baby. That is why more often stillbirth also accompanies the obstetric fistula. In due course, the dead tissues will disintegrate, creating a hole/fistula in the walls separating the woman’s reproductive and excretory systems. Depending on the spot, obstetric fistula results in constant leaking of urine and/or feces through the vagina.
What Are The Types Of Obstetric Fistula?
Depending on the location, there are several possible types of obstetric fistula. These include:
- Vesicovaginal fistula (VVF), fistula formed between the bladder and vagina
- Urethrovaginal fistula (UVF), fistula formed between the urethra (bladder outlet) and vagina
- Rectovaginal fistula (RVF), fistula formed between the rectum and vagina
- Ureterovaginal fistula, fistula formed between the ureters (kidney tubes) and the vagina
- Vesicouterine fistula, fistula formed between the bladder and the uterus (womb)
Sometimes, to complicate the matters, more than one type of fistula may occur at the same time, where damage is severe.
Who Is At The Risk Of Obstetric Fistula?
Women who live in low-resource countries who give birth without access to medical help are more prone to obstetric fistula. The key risk factors for obstetric fistula are:
- Not having access to medical facilities, obstetric care, and emergency C-section options
- Lack of well trained, skilled medical staff
- Not having access to medical supplies and equipment
What Are The Causes Of Obstetric Fistula?
Obstetric fistula is generally an issue of underdeveloped countries. Prolonged, unattended labor is the basic cause of obstetric fistula. Other probable reasons of vaginal fistula include:
- Poorly performed abortions
- Use of episiotomy and forceps during labor
- Low-quality C section
- Sexual abuse or rape
- Trauma during surgery performed in vagina, perineum, anus, or rectum
- Pelvic fracture, resulting in a complicated labor
- Radiation therapy for cervical cancer
- Early marriages and childbirth, malnutrition, and poverty can indirectly pave the way to obstetric fistula
What Are The Impacts Of Obstetric Fistula In Women?
- Obstetric fistula is often compounded by chronic medical problems, depression, social isolation
- In spite of the efforts to stay clean, the smell of leaking urine or feces is hard to get rid of and difficult to overlook. A woman with obstetric fistula is too often rejected by her husband and pushed out of her village due to her foul smell
- Rashes and infections always accompany obstetric fistula
- More often women who contract obstetric fistula also have to go through the grief of losing a child
- In some communities, a woman with obstetric fistula is not allowed to attend religious observances
- For many women, profound social isolation is worse than the physical torment
What Is The Aim Of The Campaign To End Obstetric Fistula?
In 2003, UNFPA and its partners launched the global Campaign to End Fistula, which is now active in more than 50 countries. The campaign to End Fistula has a well-planned vision, technical guidance, and support. They provide enough medical supplies and trained health workers, including surgeons, midwives, nurses and community workers not only to prevent and treat fistula but also to rehabilitate and reintegrate fistula survivors. Coming to the treatment of obstetric fistula, unfortunately, 49 out of 50 are not able to undergo adequate treatment. This is mainly because most women with the condition do not know that treatment is available, and most times they cannot afford surgery and post-operative care. This will be taken care of by the campaign to end fistula. Coming to the fistula survivors, the rehabilitation projects of the campaign aim to help the patient to get back her life. For this, the campaign provides counseling to restore her self-confidence, job training, and health so that the women reintegrate into their communities, rebuild their lives, and regain their dignity.
How Can We Prevent Obstetric Fistula?
Prevention is the key to end obstetric fistula.
- Avoiding child marriage and early pregnancy
- The cessation of harmful traditional practices
- Timely access to obstetric care
- Ensuring skilled medical attendance to attend the delivery
- Provide timely and high-quality emergency obstetric care for all high-risk pregnancies
How To Treat Obstetric Fistula?
The treatment for obstetric fistula focuses on:
- Close the hole surgically
- Attain continence
- Bring back normal sexual life and fertility
- Make certain a safe delivery in the future pregnancies
- Most importantly, help the patient back into the community
Based on the extent of the damage and size and location of the fistula, surgical intervention effectively treats 80-95% of obstetric fistula
It’s Time For Some Obstetric Fistula Facts:
- Obstetric fistula is still prevalent in parts of the world because healthcare systems fail to provide quality maternal care
- Obstetric fistula is rare in developed countries. If happens, its due to pelvic surgery rather than obstructed or prolonged labor
- Training local health workers is the key to eliminating obstetric fistula
- Nearly 50 percent of all obstetric fistula patients are between the ages of 10 and 19. Child brides, especially those in their early teens are at higher risk for this condition
- Without treating the condition, women with obstetric fistula cannot have another baby
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