They say that for every woman that dies during childbirth, another 20 to 30 women suffer severe morbidity.
One of the most devastating injuries that can occur during childbirth is obstetric fistula. Despite being one of the most devastating injuries, it is also one of the most preventable and treatable.
Every year around 50,000-100,000 women are affected by obstetric fistula. This estimate is so broad as many women hide their suffering or are unable to reach care. Obstetric fistula occurs as a result of prolonged, obstructed labor without qualified support. Prolonged, obstructed labor results in a breakdown of the wall between the vagina and bladder or vagina and rectum, allowing urine/faeces to leak through out of the vagina. The majority of cases occur in women and girls who live in extreme poverty. They are more likely to be far from healthcare centers, are generally poor in health, and malnourished, which makes them vulnerable to difficult labor. Furthermore, women living in poverty are more likely to get pregnant at a younger age when their pelvis has not fully developed, making obstructed labor more likely. Sadly, when a fistula occurs, most women do not know what is wrong with them. The constant leakage of urine or faeces as a result of the fistula leads to shame, stigma and isolation, not only by society but also by their own families. Women are therefore scared to seek medical services, and without treatment their socioeconomic status worsens.
Obstetric fistula is entirely preventable. This means, in countries where it is endemic, not only are health systems failing to protect women and girls, but so is society and government. In countries where women have economic and social opportunities, and access to health care, obstetric fistula has been virtually eliminated. The low status of women and girls in certain parts of the world is what makes obstetric fistula endemic. Young girls are at highest risk of developing obstetric fistula as their bodies are not fully formed, and so where child marriage exists, obstetric fistula will also exist. The absence of family planning programs that could protect these girls from early pregnancy compounds this problem even further. The low status of women means women do not eat well compared to other family members resulting in them being malnourished. Impoverished families will also not spend money for medical care during pregnancy. Therefore, if labor becomes prolonged or obstructed, women do not have access to a health professional. Women living in rural areas are even more disadvantaged by not having the means to obtain transport to medical facilities.
The causes of fistula are both physical and social. Therefore, preventing and fixing fistulae require physical and social solutions.
Preventing and fixing obstetric fistulae requires functioning and accessible health systems. Governments need to do more on making pregnancy care more affordable and accessible to those living in poverty. Secondly, health systems need to have trained professionals who can recognize and manage difficult labors. Essential medicines and emergency obstetric equipment should also be present in facilities. In addition, for women who are currently living with fistulae, governments need to prioritize fistula repair by partnering with international and local organizations to train healthcare professionals in repair surgeries. This is important to break the cycle of poverty and isolation that these women experience. Open campaigns to advertise repair centers, and to address stigma through education and dialogue are required in order to make it safe for women to seek care.
Preventing and treating fistula is about improving basic maternal health services. However, the root cause of fistula is embedded within the status of women. Ending child marriage, improving economic opportunities for women, and improving the education of girls is needed to eradicate fistula in the long term.
Jean M. Bouquet, DO, is an Assistant Professor of Family Medicine and Co-Director of the Urban Underserved Track at the Rocky Vista University College of Osteopathic Medicine. He is the founder of the Bouquet Speculum, an innovative and FDA-cleared medical device that helps to screen women for cervical cancer. Dr. Bouquet also started the Cure Cervical Cancer nonprofit. The following blog post was written by Dr. Bouquet about his journey to creating the Bouquet Speculum.
Dr. Daniel Kimani is a trained and licensed medical officer in Kenya, holding a Bachelor of Medicine & Surgery, and a post-graduate certificate on basic oncology training. Dr. Kimani is the founder of the Global Cancer Care and Research Institute, and is an expert in clinical colposcopy — a procedure to examine the cervix, vagina, and vulva.