MHTF Blog [Part 1] Obstetric Fistula: A Global Maternal Health Challenge

Originally posted on MHTF Blog. 

By: Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public Health; Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Fistula—a hole between the birth canal and another organ (typically the bladder or rectum)—is a tragic maternal morbidity, particularly in low-resource settings. There are several different types of fistulas including:

Obstetric fistula (OF) is the most common type of fistula and—because of its relationship to obstructed or prolonged labor—is linked to maternal mortality. Women with OF face a number of physical, emotional and social challenges, including chronic leaking of urine or feces. Due to the resulting odor, women with OF are often isolated and vulnerable to stigmatization.

Women who experience OF are also at greater risk of developing infertility problems and maternal and neonatal complications in subsequent pregnancies including:

– Miscarriage and stillbirth
– Maternal and neonatal death
– Uterine rupture
– Anemia
– Recurrent fistula
– Urinary tract infections

Global advocacy efforts to eliminate OF have increased in recent years, particularly following the United Nations Population Fund’s establishment of the Campaign to End Fistula in 2003. However, much more work is needed to close the gaps in OF prevention and treatment.

Prevention and treatment

OF can be prevented with timely, high quality maternal health care. Women living in poverty and those living in rural areas are at greater risk of developing OF, primarily because they have less access to facility-based delivery with skilled birth attendants. Distal factors such as female genital mutilation, early marriage, poverty and lack of high quality sexual and reproductive health services can also increase a woman’s risk of developing fistula. Addressing these underlying causes is key to confronting the global burden of OF.

“The women and girls who suffer from obstetric fistula are usually poor, illiterate, with limited access to health services, including maternal and reproductive health care…By ensuring safe pregnancy care, supportive input, access to well-staffed health facilities and postnatal care, many fistulas can be avoided.” – Sohier Elneil (Consultant in Urogynaecology and Uro-neurology, University College London Hospitals; former Chair of the Board of Directors, Fistula Foundation)

“Access to voluntary family planning can help families choose when and how many children to have, which is one of the most effective ways to prevent obstetric fistula.” – Mary Ellen Stanton (Senior Maternal Health Advisor, USAID)

In most cases, OF can be repaired surgically. However, successful OF treatment requires equipment, medicines, infrastructure and well-trained health care providers—including surgeons, anesthesiologists, nurses, physical therapists and often mental health counselors—resources that are lacking in many facilities.

“Typically stand-alone fistula centers do not have the capacity to properly evaluate and successfully care for these women, who often require complex, mixed treatment methods that include medication, physical therapy and, sometimes, more surgery.” – Lauri Romanzi (Project Director of Fistula Care Plus)

Many women, especially those in low-resource settings, experience financial, psychosocial and cultural barriers hindering access to treatment for OF. Furthermore, even if a woman manages to get surgical care, she will likely need support with rehabilitation and reintegration post-treatment.

Global prevalence

Global incidence and prevalence figures for OF vary across studies due to measurement challenges and  differences in methodology. Some sources have estimated that two million women around the world are living with OF. According to a 2013 systematic review, over one million women in sub-Saharan Africa and South Asia have OF, with roughly 6,000 new cases developing each year. The authors of this review reported OF rates of 1 per 1,000 women of reproductive age in low- and middle-income countries and 1.57 per 1,000 women of reproductive age in sub-Saharan Africa and South Asia alone. Additional rigorous research is critical to accurately measure the global prevalence of OF and identify regional and national disparities.

“Even one woman living with obstetric fistula is one woman too many….it causes too much devastation in the quality of life for the woman, for her family and community for program priority to be solely based on numbers.” – Dr. Joseph Ruminjo (Independent Consultant in Sexual and Reproductive Health; Clinical Lead in first-ever multinational Obstetric Fistula Needs Assessment, UNFPA/EngenderHealth)

Learn more about women’s experiences with OF and interventions to address the global burden. Subscribe to receive Part 2 and Part 3 of this mini-series>>

Learn about International Day to End Obstetric Fistula.

Join the conversation on social media by tagging @MHTF and using #EndFistula #IDEOF#FistulaDay #HerWords.