Addressing Obstetric Fistula
Obstetric fistula, a debilitating complication of childbirth, persists in many developing countries. EngenderHealth is helping to document the incidence of fistula and raise awareness of this devastating condition.
by Erika Sinclair
Ngozi, a young woman
in a rural, isolated village in Africa, is struggling to give birth.
She is in desperate need of a cesarean section, but the closest medical
facility is a four-day walk away. She waits for days, in agonizing pain,
to deliver. In the meantime, the prolonged pressure of the baby's head
against her pelvic tissue cuts off blood supply, resulting in extensive
damage to the tissue surrounding the birth canal. Her baby dies in utero,
and is finally delivered stillborn.
Ngozi survives, but notwithout injury. She has suffered a fistula—a
hole between her bladder and her vagina and/or rectum—which has
rendered her incontinent, causing her to leak urine or feces or both.
Her baby is dead, and her body is injured and smelling of waste. Adding
to this is the real threat that she may be cast out by her family and
community and left to live a life of isolation.
The World Health Organization
estimates that more than 2 million women worldwide live with fistula
and that another 50,000 to 100,000 are newly affected each year (though
the actual numbers are likely much higher). Almost all fistula cases
occur in developing countries, where access to emergency obstetric
care is poor and fistularepair services are rare.
Groundbreaking Report
As compared with other reproductive health conditions, fistula has been largely neglected. To address this problem, EngenderHealth, in partnership with the United Nations Population Fund (UNFPA), recently conducted a groundbreaking effort to assess the needs and effectiveness of fistula-repair services in nine Sub-Saharan African countries: Benin, Chad, Malawi, Mali, Mozambique, Niger, Nigeria, Uganda, and Zambia.
The report of the study, Obstetric Fistula Needs Assessment Report: Findings from Nine African Countries, highlights the need to train more local doctors in fistula surgery, and points to a heavy reliance on visiting, volunteer surgeons, which has been detrimental to the ability to provide sustained, sufficient services. As highlighted in the report, one doctor visiting Uganda worked day and night, but could operate on only 20 of the 200 women who came for treatment before he had to leave.
Ongoing Efforts
EngenderHealth's involvement with obstetric fistula did not end with
the publication of the study report. [In 2003], EngenderHealth was
awarded a four-year, $3-million grant by the Bill & Melinda Gates
Foundation to improve the prevention, treatment, and management of obstetric
fistula. EngenderHealth aims to achieve this by concentrating on increasing
the capacity of local health systems in Malawi and Niger. Our staff will
work in partnership with UNFPA and the Women's Dignity Project, a local
nongovernmental organization in Tanzania, to implement this project.
In
addition, on June 18, EngenderHealth's [then-]President, Dr. Amy E. Pollack,
and Senior Medical Associate Dr. Joseph Ruminjo presented findings
from the report at a press conference held at United Nations headquarters
in New York, garnering widespread media attention. Increased attention
to the issue of fistula continued when EngenderHealth was invited to
attend a congressional briefing on the condition in Washington, DC,
that was organized by Congresswoman Carolyn B. Maloney.
Fistula is both
preventable and treatable, and is virtually unknown in places where early
pregnancy is discouraged, young women are educated, family planning is
accessible, and skilled medical care is provided at childbirth. EngenderHealth
is proud to be a part of the growing efforts to address fistula.
An executive summary, as well as the full report, can be downloaded from EngenderHealth's Web site at www.engenderhealth.org/news/newsreleases/030618.html.
Erika Sinclair, a Program Associate on EngenderHealth's Maternity and Postabortion Care Team, was a member of the team that conducted the fistula assessment.
| Obstetric Fistula Needs Assessment Report: Findings from Nine African Countries— the first report of its kind— shows that many fistula sufferers are abandoned by their husbands, forced out of their homes, ostracized by family and friends, and even disdained by health workers, who consider them to be "unclean." Without skills to earn a living, some of these women have no choice but to beg or turn to sex work to survive. Women living with fistula in Sub-Saharan Africa usually are under age 20 (some are as young as 13), illiterate, and poor, according to the findings. |  |
| Prior to this study, the scope of this devastating maternal health issue was unknown beyond a country or two. This rapid needs assessment uses the same tools and approaches to describe the problem in nine countries—Benin, Chad, Malawi, Mali, Mozambique, Niger, Nigeria, Uganda, and Zambia. The findings document existing fistula repair services, note challenges to high-quality care, and identify successful service-delivery models in each country. The needs assessment report and accompanying information kit will help guide appropriate interventions for tackling obstetric fistula—as well as the root causes of maternal mortality and morbidity—in this diverse and needy region. |