Obstetric fistula is a complicated term for a simple, devastating condition. Caused by prolonged labor or difficult births, obstetric fistula is a hole between the vagina and the rectum. When a baby’s head is pushed against the walls of the bladder or vagina during labor, it cuts off the blood supply to the area. In especially prolonged periods of labor, this lack of blood supply starves the tissue, killing it, and leaving holes. This, in turn, causes leakage of both urine and feces through the vagina.
The effects of it go beyond discomfort. The labor itself can be grueling – according to the Fistula Foundation, 75% of the women afflicted have endured labor of three days or more. Miscarriages often happen, adding emotional tragedy at the outset. After childbirth, many women are shunned for the odor caused by incontinence, abandoned by their husbands and forced out of their homes.
Highlighting the tragedy of each case, The New York Times ran a piece on Mahabouba Mohammed, an Ethiopian woman who was raped at age 13. After giving birth, she fell victim to obstetric fistula and, in Mahabouba’s case, nerve damage that stopped her from walking. Subsequently, she was taken to a hut away from the rest of the village. Before leaving her, villagers removed the door so that she would fall prey to wild animals. Hyenas appeared that night, and after fending them off with a stick, Mahabouba crawled more than 30 miles away to a missionary for help.
Mahabouba’s story is horrifying, but ultimately she was luckier than some others. Currently, out of every 50 women with fistula, one gets treated. This figure is shockingly low, and leaves many suffering the long-term effects of obstetric fistula for years, if not decades. Compounding the tragedy is that the entire treatment for each case of obstetric fistula is estimated to be a mere $300.
According to the Huffington Post, the last obstetric fistula hospital in the United States closed in 1985 because it ran out of patients. This defines irony when around 2 million women are suffering from the condition worldwide, with an estimated 50,000 to 100,000 new cases each year, the majority in impoverished areas of Asia and Africa. As Dr. Luwam Semere writes, “There is a stunning lack of resources for women who have developed fistulas.”
Surgery can fix the condition itself, and much can be done to prevent it. It is not an inherent intractability in the condition that causes the high prevalence of obstetric fistula. It is a lack of family planning, poor infrastructure (facilities and transportation) and lack of awareness of the problem among at-risk populations.
The problem gained enough awareness to prompt the UNFPA to launch the “Campaign to End Fistula” in 2003. Combating fistula does not just mean supporting an increase in medical professionals on the ground, but implementing outreach efforts and education.
For example, one innovative program in Tanzania recognizes not only the need for surgery after the event and preventative care before, but the financial barriers to treatment faced by many women already afflicted. UNFPA and a hospital based in Dar Es Salaam partnered and used a system implemented by vodaphone to send money via mobile. Funds to pay for transport to the hospital are then delivered to candidates.
Mama Hadija, a woman who lived isolated in a separate hut from her family for 25 years, is one of the lucky ones that has benefited from concerted efforts to combat the disease. After two and a half decades of suffering, an incredibly simple fix has given her her life back.
With the success rates seen in developed countries, it’s clear that combating fistula need not be overly complicated and indeed, not particularly ambitious. May 23 is the International Day to End Fistula, rallying organizations, healthcare workers and individuals to work together to implement solutions to finally end this exceedingly tragic, but highly preventable condition.