Obstetric fistula: The hidden pandemic of Africa
Thirteen year old, rejected by her husband after a traumatic labour, Terefa is now living in a hut far away from her community: Ashamed.
Terefa lost not only her baby during the traumatic labour, but also her dignity: Terefa was too young to deliver, too far away from a health centre where she could get proper help and too poor to pay for transport…
Terefa is one of the 2 million women who are suffering from obstetric fistula (OF); a condition that is rare in developed countries but daily confrontation for women in developing countries. Obstetric fistula is one of the most severe childbirth related traumas thanks to its wide spectrum of medical, social and psychological consequences. OF is an abnormal opening between women’s vagina and bladder and/or rectum due to a obstructed labour. The fistula is responsible for constant leaking of urine/faeces and greater risk of infections, infertility and damage of vaginal tissues, which stand pleasant sexual contact in the way.
But the most important consequences of obstetric fistula are the social burden it has; communities still see OF as a curse and therefore abandon the women from their communities. Leaving the women with nothing else then the cloth they are wearing. The United Nations Population Fund (UNPFA) writes in its Living Testimony: “Women living with fistula are the survivors, yet their lives are devastated and in most cases their voices have been silenced.”
More than 500 000 women die worldwide because of obstructed labour and around 210 000 000 women are left with disabilities after a traumatising childbirth. Despite these high numbers and the impact OF has on rural female communities in Africa, it is still a hidden condition. The reason OF is still unknown with a larger public namely relies in the fact it hits the illiterate poor young women in remote regions. Obstructed labour is caused by a small pelvic which enables the mother to give birth without any medical help. Therefore the labour can take days or even weeks and often results in the deaths of both mother and child.
When the mother survived, the long labour often results in dead tissue between bladder and vagina/rectum (a fistula due to pressure) and a dead baby. Globally obstructed labour occurs around 5% of life births and counts for 8% of the maternal mortality rates.
But why is OF mostly seen in rural communities in developing countries? This question can be answered like most of the questions that are rising when we are talking about health inequalities between the developed countries and the countries that are less developed: Lack of resources. Whereas women in developed countries get regular antenatal care, women in rural regions in developing countries are pregnant without even having the possibility to think of antenatal care. The highest rate of obstetric fistula is seen in regions emergency obstetric care, referral systems and infrastructures are poor.
Once OF occurs it is easy to repair by surgery: for more than 90% of the women one surgery is enough to heal the fistula. This cure means that the women are able to life their life again up to the fullest, including having babies. Unfortunately not many women know about the possibilities of cure and if they do, these services are mostly too far away and too expensive.
Because of the Millennium Development Goals of the United Nations there is a worldwide effort to reduce maternal mortality by 75% up to 2015. Since 2003 the global Campaign to End fistula worked on reducing the high rates of obstetric fistula trough research, programme interventions and to improve and increase access to treatment services for women with obstetric fistula. In 2007 the award-winning documentary about OF came out: ‘A walk to beautiful’ from Mary Olive Smith won over 6 awards in the year 2007. A walk to beautiful tells the story of five women, living in Ethiopia, suffering from obstetric fistulas due to obstructed labour.
Up to this moment just a few specialized fistula hospitals and services exist in parts of Ethiopia, Nigeria, Niger, Pakistan, Sudan and Tanzania.
This article just highlights the tremendous amount of consequences obstetric fistula has for women in rural regions in developing countries around the world. For more information read:
1. “ Preventing and treating obstetric fistulas in Nigeria” (Medecins sans Frontieres, 2011)
2. “Fistula reconstructive surgery returns lives, dignity and well-being” (MSF, 2011)
More information about the documentary ‘A walk to beautiful’ on: