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The Newest Epidemic in Africa: Obstetric Fistula
Obstetric fistula, the most devastating and serious of all childbirth injuries, should be granted a crisis status and global leaders must address the problem that currently affects 3.5 million women globally.
Obstetric fistula was conquered by the west in the early 1900s but it is sad that most mothers in poor countries are still affected by the condition because they give birth without any medical help. So many of these mothers are young girls between 13 and 20 years old.
In an exclusive interview with this author, fistula expert and Africare Zambia Program Manager (for maternal and child health) Meredith Budge explained how fistula patients have to endure days of agonizing, obstructed labour that their bodies end up literally broken by childbirth.
- “During labour contractions, the baby’s head is constantly pushing against the mother’s pelvis bone – causing tissue to die due to lack of blood flow to this area,” Budge says. “All of that pushing creates a hole, or in medical term a 'fistula' between the birth passage and an internal organ such as the bladder or rectum. A woman cannot hold urine, and sometimes bowel content as well. The baby is unlikely to survive. Only seven percent of women with fistula end up with a live baby.”
Budge further explains that if she survives, a woman with fistula is likely to be rejected by her husband because of her inability to bear more children and her foul smell.
- “These women suffer profound psychological trauma resulting from their utter loss of status and dignity, in addition to suffering constantly from their physical internal injury,” she adds.
This number of the affected keeps growing bigger. According to the Worldwide Fistula Fund (WFF), each year approximately 100,000 women develop fistula or 273 each day.
The number is staggering. Right now, millions of women are suffering from this heartbreaking, treatable childbirth injury because they are too poor to afford surgery that costs about $450.
It can be cured
Fistula can be cured and conquered if global leaders show political will and fund the work of those who are at least trying to do something about the problem.
The WFF reports that the international capacity to treat fistula patients has been estimated at 6,500 each year or 18 patients each day. There is clearly an overwhelming need for treating far more women.
Obstetric fistula can be cured. The world should not ignore the troubled women who are affected by fistula, most of them are suffering in silence.
- Fistula used to be present in the U.S. and Europe, but was largely eliminated in the latter part of the 19th century and early 20th century with improved obstetric care in general and the use of c-sections in particular to relieve obstructed labor.
- The World Health Organization estimates there may be as many as 50,000 — 100,000 new cases of fistula each year, yet the global treatment capacity is less than 20,000 cases a year.
- There is a large unmet need for treatment. Fistula is most prevalent in sub-Saharan Africa and Asia.For example, in Ethiopia, there are an estimated 100,000 women suffering with untreated fistula, and another 9,000 women who develop fistula each year.
- Less than 6 in 10 women in developing countries give birth with any trained professional, such as a midwife or a doctor. When complications arise, as they do in approximately 15% of all births, there is no one available to treat the woman, leading to disabling injuries like fistula, and even death.
- The root causes of fistula are grinding poverty and the low status of women and girls. In developing countries, the poverty and malnutrition in children contributes to the condition of stunting, where the girl skeleton, and therefore pelvis as well, do not fully mature. This stunted condition can contribute to obstructed labor, and therefore fistula. But, fistula is both preventable and treatable. For instance, the Addis Ababa Fistula Hospital has treated over 30,000 women over 33 years. Their cure rate is over 90%. Fistula can be prevented if laboring women are provided with adequate emergency obstetric care when complications arise.