United Nation’s International Day to End Obstetric Fistula is marked worldwide on 23 May.
This year’s theme, “End fistula, restore women’s dignity” which the UN Secretary-General Ban Ki-moon said would serve as an opportunity for world leaders to commit to ending the scourge of fistula in our lifetime. “We have a moral obligation, as a global community, to complete the unfinished agenda of eradicating fistula,” he added.
What is obstetric fistula?
Obstetric fistula is a tear or a hole between a woman’s birth canal and one or more of her internal organs (such as the bladder or rectum) resulting in permanent incontinence.
When the hole develops between the between the bladder and the vagina, it is called vesicovaginal fistula, and when it is between rectum and the vagina, it is called rectovaginal fistula.
It is most often caused by prolonged and obstructed labor during which the mother does not receive adequate treatment or care. More than 75% women with obstetric fistula have endured labor that lasted three days or more.The baby almost always dies during labor. And the mothers i.e the sufferers often endure depression, social isolation and deepening poverty. Many women live with the condition for years – or even decades – because they cannot afford to obtain treatment.
It is a debilitating condition, to say the least. Without proper treatment, women with an obstetric fistula can face a lifetime of suffering, unable to control the discharge of urine or fecal matter. They are often ignored and discarded, abandoned by their husbands and families, and they find themselves effectively ostracized from society. Girls drop out of school, women cannot work, and are often left to live a life of isolation.
Fistula is almost entirely preventable. It is also a treatable condition. Yet it is estimated that more than 2 million (young) women live with untreated obstetric fistula in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean, and some 50,000 to 100,000 new cases develop each year. Between 3,500 and 5,000 cases of obstetric fistula occur in Pakistan each year and there are 4500-5500 new obstetrics fistula cases in East Africa alone, annually!! Thousands of women simply suffer in silence, unaware that they can seek medical assistance.
The persistence of obstetric fistula is a sign that health systems are failing to meet women’s essential needs.
Evidence has shown that obstetric fistulae can largely be avoided by delaying the age of first pregnancy, by the cessation of harmful traditional practices and by timely access to quality obstetric care.
Adolescent girls are particularly at risk of maternal deaths and morbidities, including obstetric fistula. And with over 16 million adolescent pregnancy per year globally, it is not surprising that adolescent contribute significantly to the burden of obstetric fistulae.
Obstetric fistulae are prevalent in area where harmful cultural/traditional practices such as female genital mutilation and child bride are predominantly practiced. They also occur among women living in poverty in cultures where a woman’s status and self-esteem may depend almost entirely on her marriage and ability to bear children. In other parts of the world, obstetric fistulae are not considered as medical conditions but rather as a “punishment” for women being disloyal to their families, or as a divine punishment for carrying a venereal disease. These perceptions, along with the physical symptoms, mean many of the women live in isolation, poverty and shame, perhaps for life!
There is hope. Patients with uncomplicated fistulae can undergo a simple surgery to repair the hole in their bladder or rectum. Approximately 80-95% of vaginal fistula can be closed surgically.
To commemorate this year’s International Day to End Obstetric Fistula, UNFPA Executive Director Dr. Babatunde Osotimehin admonished, that as the world shapes a new development agenda, a new opportunity has presented itself… “Let us decide, as a global community, that the world we want is one where fistula no longer exists,”he said, adding: “Let us, once and for all, put an end to this assault on women’s and girls’ health and human rights, which steals from them their very dignity and destroys the most fundamental of human qualities: hope.” (The Campaign to End Fistula was launched by UNFPA and partners in 2003).