Obstetric fistula

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Overview

Obstetric fistula is one of the most serious and tragic injuries that can occur during childbirth. It is a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labour without treatment. It leaves women leaking urine, faeces or both, and over time, it leads to chronic medical problems. Sufferers also often endure depression, social isolation and deepening poverty.

An estimated 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are living with this injury, and some 50,000 to 100,000 new cases develop each year. Yet fistula is almost entirely preventable. Its persistence is a sign that health systems are failing to meet women’s essential needs.

UNFPA provides medical supplies, training and funds to fistula prevent, treatment and social reintegration programmes. UNFPA also strengthens maternal health and emergency obstetric services to prevent this injury from occurring in the first place.

How it happens

Without intervention, obstructed labour can last for days, resulting in death or severe disability. Without treatment, the obstruction can cut off blood supply to tissues in the woman’s pelvis. When the dead tissue falls away, she is left with a hole – a fistula, in medical terms – in the birth canal.

There is a strong association between fistula and stillbirth, with research indicating 78 to 95 per cent of women who develop obstetric fistula end up delivering a stillborn baby.

Obstetric fistula has been essentially eliminated in industrialized countries by the availability of treatment for prolonged and obstructed labour – typically, Caesarean sections.  Today, obstetric fistula occurs mostly among women and girls living in extreme poverty, especially those living far from medical services. It is also more likely to afflict girls who become pregnant while still physically immature. In some places, one in three women with obstetric fistula say they developed the condition while still an adolescent.

Consequences for women

Left untreated, obstetric fistula causes chronic incontinence and can lead to a range of other physical ailments, including frequent infections, kidney disease, painful sores and infertility. The physical injuries can also lead to social isolation and psychological harm: Women and girls with fistula are often unable to work, and many are abandoned by their husbands and families and ostracized by their communities, driving them further into poverty. 

The continued occurrence of obstetric fistula is a human rights tragedy, reflecting the marginalization of those affected. Their isolation means they often go unnoticed by policymakers, and as a result, little action is taken to address or prevent their condition.

Treatment, reintegration

Reconstructive surgery can usually repair a fistula. Unfortunately, the women affected by this injury often do not know about treatment, cannot afford it or cannot reach the facilities where it is available. 

Counselling and other forms of support – such as job training – may also be necessary to help women reintegrate into their communities after they have been treated.

Prevention is key

Prevention is the key to ending fistula. Ensuring skilled birth attendance at all births and providing emergency obstetric care for all women who develop complications during delivery would make fistula as rare in developing countries as it is in the industrialized world. Additionally, providing family planning to those who want it could reduce maternal disability and death by at least 20 per cent.

The underlying factors that contribute to women’s and girls’ marginalization – including lack of access to health services and education, persistent poverty and gender inequality, child marraige, adolescent pregnancy and failure to protect human rights – must also be addressed.

UNFPA response

In 2003, UNFPA and its partners launched the global Campaign to End Fistula. The Campaign works in more than 50 countries to prevent and treat fistula, and to rehabilitate and empower fistula survivors. Since the start of the Campaign, UNFPA has supported over 47,000 fistula repairs. In 2013 alone, UNFPA supported over 10,700 fistula repairs.

Since 2008, almost 9,000 women and girls have received reintegration services, including skills training and small grants to start businesses, with support from the Maternal Health Thematic FundUNFPA has also supported the training of nearly 4,000 health workers, including surgeons, midwives, nurses and community health workers. These health professionals all play a crucial role in treating fistula and preventing its occurrence in the first place.

In 2013, the United Nations commemorated the first International Day to End Obstetric Fistula, on 23 May, to raise raised awareness of this issue and mobilize support around the globe.

Selected videos

See more videos on obstetric fistula

Selected links

Campaign to End Fistula