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
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.
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