Obstetric fistulas: millions of women have experienced incontinence, shame, and isolation due to this preventable childbirth injury

Obstetric fistula is a serious health issue that disproportionately affects young women in developing countries. In this piece, we will discuss the medical, social, and emotional consequences of obstetric fistula, as well as what can be done to prevent and treat it. But first, a bit of background information:

What is obstetric fistula?

By VHenryArt – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=38032188

An obstetric fistula is a hole between the bladder or rectum and the vagina, which causes women to leak urine or feces or both.

Obstetric fistulas are typically caused by several days of obstructed labor associated with fetal malpresentation or cephalopelvic disproportion (when the fetal head is too large to fit safely through the maternal pelvis) (1).

If the vaginal tissue is trapped between the fetal head and the bony pelvis for too long, the tissue will begin to die due to lack of blood flow (1, 2). Obstetric fistulas usually develop between three and 10 days after a woman gives birth (1). Devastatingly, most women who have an obstetric fistula also deliver a stillborn baby (3).

Note: obstructed labor is also a major cause of maternal mortality (4).

How common are obstetric fistulas?

In Asia and sub-Saharan Africa, an estimated two million young women have an untreated obstetric fistula (4). This condition is much more prevalent in poor countries (see next section).

Who is most at risk for an obstetric fistula?

Women are more likely to experience an obstetric fistula if they:

  • Live in a developing country. Obstetric fistulas were once prevalent in the United States and Europe, but have been virtually eliminated due to advances in obstetric care and the availability of C-sections for women with obstructed labor. Obstetric fistulas are much more common in developing nations (5).
  • Are young and have never previously given birth. Adolescents are much more likely to suffer from obstetric fistula (pelvic immaturity increases the risk of cephalopelvic disproportion) (1).
  • Are malnourished. Poverty is a risk factor for obstetric fistula not only because of lack of access to healthcare, but also because malnutrition can lead to skeletal stunting (including of the pelvis) and make vaginal birth very dangerous. Further compounding this issue, girls in developing countries often give birth very young, when their pelvises may be small due to both immaturity and stunting (1, 5).
  • Are grand multiparas (i.e. have given birth many times) and have loosened uterine muscles. This increases the risk of fetal malpresentation (1).

In first world countries, medical professionals should be able to prevent obstetric fistulas. If they fail to do so, they have likely been negligent. Women may be able to pursue a medical malpractice lawsuit.

What other medical problems are associated with obstetric fistulas?

Women with an obstetric fistula often suffer from comorbidities such as the following (1, 4):

  • Amenorrhea (absence of menstrual periods)
  • Foot drop (dragging of the foot). This is likely due to nerve compression during obstructed labor. In one study, 38 percent of fistula patients had affected lower limbs.
  • Neurogenic bladder dysfunction
  • Skin problems due to urine and feces leakage
  • Kidney disorders

As mentioned earlier, women with obstetric fistulas also often lose their babies during the birthing process. The rate of stillbirth may be as high as 94 percent (3). The same complications that cause obstetric fistula (obstructed labor due to fetal malpresentation or cephalopelvic disproportion) are also associated with neonatal brain damage. Surviving babies may be at higher risk of developing long-term disabilities such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP). (Please note that if your child was born in the United States and has one of these conditions, our firm may be able to help you pursue a birth injury lawsuit.)

What social and emotional issues are associated with obstetric fistula?

The social and emotional consequences of obstetric fistula can be profound. In addition to likely experiencing the loss of a baby, women with obstetric fistulas often suffer from extreme shame and social isolation.

They often have a foul smell due to chronic incontinence (2) and may be unable to have sexual intercourse or bear children (1, 6). In many cases, women with obstetric fistulas are rejected by their communities.

Keflene Yakoba, a young woman in Tanzania, told the United Nations Population Fund:

“It has been a very difficult time in my life. People have laughed at me. I couldn’t join any social gatherings. I couldn’t attend church, and I couldn’t even visit my friends. Some community members shunned me because of my condition.”

Husbands of women with obstetric fistulas often abandon them or seek a divorce. In fact, in Niger, 63.3 percent of all divorces can be attributed to fistulas (1).

Furthermore, most women who have obstetric fistulas live in cultures in which a woman’s self esteem and social status may be heavily dependent upon being married and rearing children (4).

What can be done to help women with obstetric fistulas?

There are a variety of international public health initiatives aimed at preventing and treating obstetric fistulas.

Prevention

In addition to improving access to healthcare and providing medical professionals in developing countries with more advanced training and resources, fistula prevention efforts involve broader initiatives to empower girls and women. Promoting education and discouraging child/adolescent marriage can delay reproduction and reduce the risks associated with physical immaturity (1). Providing women with a source of income/skills training may also reduce vulnerability to obstetric fistulas and other medical issues associated with malnutrition, lack of access to healthcare, etc.

Treatment

Most fistulas can be repaired with a surgical procedure; the success rate may be as high as 90 percent (1). Unfortunately, very few women with obstetric fistulas actually get this surgery. For every woman who has the procedure, 50 or more go without (2): in some cases, for decades (3). Many cannot afford treatment; many others do not even know their condition can be resolved. Shame may also prevent some from seeking help (1).

Therefore, in addition to providing the funds for treatment (as well as associated transportation, lodging, and food costs), outreach efforts are critically important (7). These efforts can include radio ads, community plays, and training outreach workers. In many cases, women who have already been treated serve as “ambassadors” in their communities, trying to reduce stigma surrounding obstetric fistula and increase awareness of treatment opportunities (1, 7).

How can I help?

The Fistula Foundation notes that, “While $586 isn’t enough for one night’s stay in most hospitals in the United States, it is typically enough to provide one woman with restorative surgery and postoperative care.”

Donations towards these surgeries (tax-deductible within the United States) can be made here. The Fistula Foundation also runs a “Circle of Friends” program, which helps people run fundraisers to support their work.

There are a variety of other organizations that work to prevent and treat fistulas. To learn more about these, and how to donate, click on the following links:


About ABC Law Centers

ABC Law Centers is a medical malpractice firm that advocates for babies and children (in the United States) who have been harmed as the result of a preventable birth injury. This includes some of the same issues that can lead to obstetric fistulas, such as mismanaged cephalopelvic disproportion and macrosomia. Children with birth injuries may develop permanent disabilities such as cerebral palsy and epilepsy.

If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win.

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Sources

  1. Obstetric Fistula: A Preventable Tragedy. (2005, July 25). Retrieved June 7, 2019, from https://www.medscape.com/viewarticle/507500_4
  2. Fistula Foundation. (n.d.). Retrieved June 6, 2019, from https://www.fistulafoundation.org/what-is-fistula/
  3. Think Equal: Obstetric fistula. (n.d.). Retrieved June 6, 2019, from https://www.figo.org/news/think-equal-obstetric-fistula-0016159
  4. 10 facts on obstetric fistula. (2018, February 06). Retrieved June 6, 2019, from https://www.who.int/features/factfiles/obstetric_fistula/en/
  5. Fistula Foundation. (n.d.). Retrieved June 6, 2019, from https://www.fistulafoundation.org/what-is-fistula/fast-facts-faq/
  6. Pope, R., Ganesh, P., Chalamanda, C., Nundwe, W., & Wilkinson, J. (2018). Sexual Function Before and After Vesicovaginal Fistula Repair. The journal of sexual medicine, 15(8), 1125-1132.
  7. Ending obstetric fistula: Devastating and preventable childbirth injury continues to haunt women. (2019, May 21). Retrieved June 6, 2019, from https://www.unfpa.org/news/ending-obstetric-fistula-devastating-and-preventable-childbirth-injury-continues-haunt-women

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