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Produced for LMC-TVbyFran Snedeker |
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Produced for LMC-TVbyFran Snedeker |
The Hidden Heartbreak
If you live in the Western world, you may never have thought about obstetric
fistula. The last hospital in the United States that treated the condition
closed in 1895. Although it is very rare, and usually treated, in developed
countries, this devastating childbirth injury is widespread in the developing
world, where an estimated 2 million women suffer from the debilitating
aftereffects of prolonged obstructed labor.
An obstetric fistula is a hole between the birth canal and one or more of a woman's internal organs, usually the bladder and/or the rectum. The hole develops after several days of labor, when the pressure of the baby's head against the mother's pelvis cuts off blood supply, causing tissue to die. Girls and women with an obstetric fistula steadily leak urine or feces. They frequently face social isolation because of their odor. In communities that pressure women to have children as a sign of womanhood, the social stigma of stillbirth and obstetric fistula can be devastating.
Girls
ages 16–19 experiencing their first pregnancy are the women who
most commonly develop a fistula. In regions where early marriage is the
norm, even younger girls are at risk. Young women who have not fully
matured have a pelvis that is too small to withstand childbirth. Furthermore,
because of extreme poverty, these girls tend to have inadequate nutrition
and no formal education. Access to critical family planning services
is often limited, and young women usually lack the social power to make
choices for themselves about health care and pregnancy.
Because of lack
of understanding and social stigma, women with fistula often suffer in
silence. The scope of obstetric fistula in the developing world has come
to light in recent years because of the efforts of EngenderHealth,
the United Nations Population Fund (UNFPA), the Women's
Dignity Project, and others
working to raise awareness and assess the problem.
| "We have realized there are many more cases. Many of these women are hidden away." |
In 90% of cases, obstetric fistulae can be surgically
repaired. Women who receive appropriate treatment can go on to have children,
usually by cesarean section. However, many factors prevent poor, isolated
women from seeking help:
•
Lack of awareness of a possible cure.
• Lack
of financial resources. A fistula repair costs about $300, beyond the
means of the very poor.
• Lack of local health facilities. Many
affected women live far from clinics in remote areas.
• Lack of
skilled providers. Developing countries often have very few surgeons
trained in obstetric fistula repair.
• Aversion to using hospitals
for giving birth. Because trust in the safety of services is often very
low in poor areas, hospitals are often viewed as places to die.
Despite the obstacles, when high-quality surgical repair becomes available, demand for services explodes. Many women will travel for days to reach a hospital that has a surgeon who can perform fistula repair. And when women hear of a provider visiting their region, hundreds turn up for a chance at a cure, creating a large backlog.
Women in poor countries who experience prolonged obstructed labor are likely to die. Those who survive are often left with an array of physical maladies, including obstetric fistula, nerve damage, infection risk, kidney and skin problems, suppressed menstruation, and infertility. The babies are usually stillborn. Lifetime
Risk of Death in Childbirth |
EngenderHealth is making strides in developing safe and effective services that address the complex physical, emotional, and social dimensions of this tragic problem. Our activities include:
• Improving access to family planning
• Advocating policy changes to tackle root causes
• Leading community prevention and education activities
• Assessing demand for services and gaps in services
• Upgrading emergency obstetric care
• Developing training programs in clinical and counseling skills for staff
• Strengthening fistula prevention and repair services
• Training surgical teams at multiple hospitals
• Creating and supporting "model" facilities for fistula clients
• Identifying unmet needs, such as fistula resulting from trauma (rape) in conflict zones
Our fistula work is broadly applicable in poor countries across the globe. We are working with health systems in Bangladesh, Ethiopia, Niger, Tanzania, and Uganda, and are initiating projects in Sudan and other countries.
Some of our partners and supporters in this effort include: The Bill & Melinda Gates Foundation, the U.S. Agency for International Development, the United Nations Population Fund, the Department for International Development (UK), and the Women's Dignity Project (Tanzania).