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HOME: STATE OF WORLD POPULATION 2004: Maternal Health
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Maternal Health

New Approaches
Causes and Consequences
Maternal Morbidity
Obstetric Fistula
Reducing Maternal Mortality and Morbidity
Difficulties in Measurement
Holistic Responses
Antenatal Care
Skilled Attendance
Emergency Obstetric Care
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UNFPA and Safe Motherhood

Obstetric Fistula

Obstetric fistula, a devastating maternal morbidity, is one of the most neglected issues in international reproductive health. Caused by prolonged and obstructed labour, a fistula is a hole that forms between a woman’s vagina and bladder or rectum, leaving her with chronic incontinence. In most cases, the baby dies.

Women with fistula are unable to stay dry. The smell of urine or faeces is constant and humiliating. The social consequences are equally tragic: many girls and women with fistula become ostracized by society, abandoned by their husbands and blamed for their condition.

Fistula is more than a women’s health problem. It typically affects the most marginalized members of society—poor, illiterate girls and young women living in remote areas. Root causes include early childbearing, malnutrition and limited access to emergency obstetric care. Widespread in sub-Saharan Africa, South Asia and some Arab States, fistula affects more than 2 million girls and women worldwide, with an estimated 50,000 to 100,000 new cases annually.(20)

Fistula is preventable through efforts to postpone early marriage and pregnancy, increased access to family planning services, and timely access to emergency obstetric care—particularly Caesarean section to relieve obstructed labour. It is treatable through surgical repair, with success rates as high as 90 per cent for uncomplicated cases. Most women return to a full and normal life after counselling, social rehabilitation and reintegration in their community.

However, the cost of transportation to reach help, corrective surgery and recovery care (about $300) is often prohibitive. Treatment facilities are few and far between, and there are not enough specially trained doctors and nurses available.

INFANT MORTALITY. Where mothers are at high risk of maternal death or illness, their children are at risk, too. Neonatal and infant deaths can result from poor maternal health and inadequate care during pregnancy, delivery and the critical immediate postpartum period.(21) Infections and birth asphyxia and injuries account for the majority of neonatal mortality, but low birth weight, complications from delivery and congenital malformations also contribute.

18 CAMPAIGN TO END FISTULA

In 2003, UNFPA launched a global Campaign to End Fistula with the aim of making fistula as rare in developing countries as it is in the industrialized world. The campaign raises awareness of the issue, conducts needs assessments, and expands services for prevention and treatment.

A key goal is to highlight the importance of emergency obstetric care for all pregnant women. Working with government partners, NGOs and the international community, the campaign is now under way in more than 25 countries.

In Bangladesh, where some 70,000 women are living with obstetric fistula, a Fistula Repair Centre at the Dhaka Medical College has been established. The centre will help manage cases and train service providers in South Asia.

In Zambia, the campaign is supporting the fistula repair unit at Monze Mission Hospital. Initial efforts have contributed to increased awareness of the problem and improved quality of care.

In Sudan, a national campaign was launched under the slogan “Fistula: We MUST Care.” UNFPA has purchased medical equipment and supplies for the Fistula Centre in Khartoum, one of the country’s only facilities. See Sources

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