“Obstetric fistula is not only a health problem, it is a condition that can isolate women and girls from their families, education, and other opportunities– Nélida Rodrigues, United Nations Population Fund (UNFPA) Representative in Mozambique.

THE poor and marginalised in every situation suffer the most. Accessing affordable medical care continues to be a serious issue. Global income inequalities are ever-increasing. Medical care is much different in the global north as against that which exists in the global south.

Undoubtedly, women and girls bear the brunt concerning global inequalities. A global culture lacking in equity serves as a reminder of gross disparities, that health and social systems are failing to protect the health, human rights and dignity of the poorest and most vulnerable women and girls. Obstetric fistula is the silent crisis impacting thousands of women.

Obstetric fistula is one of the most serious and tragic childbirth injuries. Obstetric fistula is caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It leaves women and girls leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. The United Nations (UN) states that half a million women and girls in sub-Saharan Africa, Asia, the Arab States region, Latin America and the Caribbean are estimated to be living with fistula, with new cases developing every year. Yet fistula is almost entirely preventable. It is for this reason that the international community observes May 23 each year as the International Day to End Obstetric Fistula.

This year’s theme, “Her health is a right: Invest to end fistula and childbirth injuries”, highlighted the urgent need for political commitment and financial investment to prevent the condition, provide holistic treatment, and uphold the reproductive rights of all women and girls. Some fistulas are caused during gynaecological procedures (eg, hysterectomy) and Caesarean sections due to substandard health care and inadequate surgical skills training/competence. These are called iatrogenic fistulas. Traumatic fistulas are caused by sexual violence, especially in conflict areas; the destruction of the vagina is considered a war injury.

Consequences of obstetric fistula

Survivors suffer from continuous urinary or faecal incontinence. This leads to severe chronic infections and devastating social isolation, as the associated stigma and physical discomfort often result in women being ostracised and driven further into poverty. The lives of women with the condition are defined by lifelong physical and emotional suffering. The condition can lead to infections, ulcerations, kidney disease, painful sores, infertility and death. The smell from constant leakage isolates women who are often shamed and stigmatised, abandoned by their friends and families and ostracised by their communities. They suffer from depression and suicidal thoughts and other mental health issues.

Denied livelihood opportunities, they are driven deeper into poverty and vulnerability. The UN adds that obstetric fistula has all but disappeared in rich countries with quality health care systems and skilled professionals who can perform Caesarean sections. Midwives are a vital part of the solution. The International Confederation of Midwives says “ending obstetric fistula requires the full involvement of midwives at the community, national, regional and global levels.” Apart from a lack of quality health services, poverty is a major social risk because it is associated with early marriage and malnutrition. Childbearing before the pelvis is fully developed as well as malnutrition, small stature and generally poor health conditions are contributing physiological factors to obstructed labour. However, older women who have already had babies are at risk as well. Although the number of obstetric fistula have declined over the past two decades, too many women and girls especially the most vulnerable still live with its devastating, lifelong consequences, including stigma, poor health and lost opportunities.

Fistula a men’s issue, too

Yes, obstetric fistula is a man’s issue too, although not in the biological sense. Husbands often suffer alongside their wives, experiencing distress, grief from the loss of the baby (which occurs in roughly 90 per cent of obstetric fistula cases), and the emotional weight of seeing their partner in chronic pain. Maternal health is not only a woman’s issue but also a man’s issue and vital to society as a whole. Gender power imbalance has consistently been shown to have serious implications for women’s reproductive health and is known to persist in regions where obstetric fistula occurs. Men play a vital role in preventing it by making household decisions regarding family planning and arranging transportation to hospitals when labour complications arise. Men should be active participants in the welfare of their partners and their children.

Prevention and treatment

Access to family planning to reduce unplanned/early pregnancies and the availability of emergency obstetric care (including timely C-sections) are the primary methods of prevention. Ending fistula means ensuring that maternal health goes beyond survival. Every woman has the right not only to survive childbirth, but to thrive. This requires universal access to quality maternal care, including timely emergency and surgical services, as well as sustained support for survivors’ reintegration, dignity and well-being. The condition is highly curable. Reconstructive surgery can repair the tissue and restore health and dignity to the affected women.

In moving forward, governments need to place more effort in reaching the targets of the United Nations Sustainable Development Goals, especially goals number one, three and five, which are the foundation for all the other goals. Let us all lend our voices and platforms to raise awareness of this dehumanising issue and mobilise support. There needs to be a redoubling of global efforts to address obstetric fistula. More investment is needed in the prevention and treatment of obstetric fistula to strengthen health systems, as well as to enable women to participate fully in society while maintaining their dignity.

In the words of Dr Natalia Kanem, executive director at UNFPA, obstetric fistula is a tragic result of our failure to protect the reproductive rights of the most vulnerable and excluded women and girls.

Wayne Campbell is an educator and social commentator with an interest in development policies as they affect culture, and/or gender issues. E-mail waykam@yahoo.com.