How it happens
Without emergency intervention, obstructed labour can last for days, resulting in death or severe disability. Without timely, high-quality 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.
Tragically, 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 – namely, 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.
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 violation, reflecting the marginalization of those affected and the failure of health systems to meet their needs. Their isolation means they often go unnoticed by policymakers, and as a result, little action is taken to address or prevent their condition. As a result, women and girls suffer needlessly, often for years.
Treatment, reintegration and follow-up
Reconstructive surgery can usually repair a fistula. Unfortunately, the women and girls affected by this injury often do not know that treatment is possible, cannot afford it or cannot reach the facilities where it is available.
Counselling and other forms of support – such as livelihood skills, literacy, job training and health education – may also be necessary to help women reintegrate into their communities, rebuild their lives, and regain their dignity and hope.
Follow-up is also crucial for all women and girls who have had fistula repair surgery, helping to ensure they do not develop the injury again during subsequent births and helping to protect the survival and health of both mother and baby.
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 quality health services and education, persistent poverty and gender inequality, child marriage, adolescent pregnancy and failure to protect human rights – must also be addressed.
In 2003, UNFPA and its partners launched the global Campaign to End Fistula, which is now active in more than 50 countries, working to prevent and treat fistula, and to rehabilitate and empower fistula survivors. Over the last 12 years, UNFPA, as the leader of the global Campaign, has directly supported more than 57,000 surgical repairs for women and girls, and partner agencies have supported thousands more.
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 Fund. UNFPA 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 awareness of this issue and mobilize support around the globe. The International Day to End Obstetric Fistula is observed annually around the world.
Updated 29 June 2015.