Obstetric Fistula: How Far We’ve Come and Where We Need to Go
05/03/2011
EngenderHealth VP of programs blogs on obstetric fistula - the unjust and unnecessary injury
Throughout the 80s and much of the 90s, I practiced medicine in Cameroon, West Africa. Time and again, I treated women in labor or just after delivery. Time and again, they were brought to me too late. Some died. Some lost their babies. Some were left leaking urine and/or feces uncontrollably, suffering from a birth injury known as obstetric fistula.
This struck me as entirely unjust and unnecessary and it strengthened my resolve to contribute to altering this reality.
An obstetric fistula occurs when a woman experiences prolonged and obstructed labor. The condition is preventable, but only if the woman receives skilled care in time. Once she develops fistula, it can be repaired with surgery, but the obstacle for the woman remains the same as those that led to the fistula in the first place - finding access to a trained surgeon at a hospital equipped with the right instruments and supplies. For many, the nearest option may be hundreds of miles away, and transportation options may be expensive or infrequent.
Because of this, at least 2 million women, mostly in Africa, suffer from obstetric fistula. The mere existence of this condition is a signal that existing health systems are failing to meet women's reproductive health needs.
Yet, we cannot ignore some of the important advances we have made in the last decade to prevent and treat obstetric fistula, arguably the most devastating of childbirth injuries. While not nearly enough, the progress to date demonstrates the potential for dramatically improving health care for women - not 100 years from now, but within the next decade.
Following the lead of stalwart fistula champions, there has been growing support over the past decade from various government agencies and organizations like USAID and UNFPA to end obstetric fistula. They recognize that women who have been so repeatedly failed deserve better. Together with funding, there has been a notable increase in programming and coordination around fistula through new professional associations, international coordination networks, national working groups, and task forces. Such collaboration has increased public consciousness and media coverage, giving voice to the needs of women with fistula.
But responding to these needs involves more than closing a hole. It requires resources and surgeons with specialized skills, both of which are scarce in many of the places where fistula occurs. Some women may require more than one surgery, as many fistulas are complex, involving multiple tissues and organs. Women with fistula have often been traumatized and stigmatized and require both physical treatment and psychosocial counseling and support before the surgery, through treatment, and to the point at which they are ready to reintegrate into their communities and families.
If this sounds daunting, that's because it is. But progress is achievable. Whether we're individuals, hospitals, or organizations, each of us has a role to play. Our efforts are part of a broader push to successfully and sustainably improve maternal health in a comprehensive way. To do this, we must build a strengthened health system that allows us to coordinate and communicate to make sure that our efforts are complementary, not duplicative. This also means working to prevent fistula in the first place by meeting women's need for contraception, skilled birth attendance, and emergency obstetric care.
This is possible if existing health systems are properly supported through partnerships with national governments and institutions. We know that this is the most sustainable approach. Not only is it the right thing to do, but it also captures both the spirit and intent of the Obama Administration's Global Health Initiative.
An estimated 100,000 women will develop obstetric fistula this year. We need to fuel the momentum to reverse this trend. Implementing a lasting solution requires thoughtful, knowledge-based collaboration that ultimately strengthens health systems - and transforms the lives of millions of women.
Isaiah Ndong, MD, MPH is vice president for programs at EngenderHealth. http://www.engenderhealth.org/our-work/maternal/fistula.php
This article is a vivid picture of the situation in most of subsaharan Africa.Management starts from skilled attendance in pregnancy an delivery and more.We thus need more than just financial and human resources which are not even available given that health is not meaningfully considered as a priority, with most subsaharan countries allocating less than 5% of their national budget for health. Who says that maternal and child health is a priority? For several years many African countries like Cameroon have not been training midvives and we cannot talk of skilled attendance.The situation could get worse unless the health managers and the law-makers who allocate budgets for various sectors become more realistic and serious, recognising health as a priority of priorities in all aspects.We know where we should be going but I am afraid that getting there is still a very long way for the people most afflicted by obstetric fistulas
— Simon Nchifor on 2011-05-06
Good to know for obstetricians!!!
— Dr. Nahar on 2011-05-14
Great knowledge
— Terence Ndifuanja on 2011-05-23
This is an inspiring arcticle. I am practicing in a rural hospital in Eastern Uganda. My experience is that majority of those who suffer fistulae are young women from rural communities. We are currently conducting a community sensitization programme with a lot of opportunites for free sharing and dialogue. What we have learnt is that rural communities are lacking information on prevention. Early marriages, teenage pregnancies, fears about contracenption and poor or lack of preparation for delivering are comming out as the key reasons for maternal morbidity and mortality. I therefore urgue stakeholders to also put more efforts on increasing the demand side such that mothers and communities are educated to champion the prevention of fistulae.
— Dr Mulongo Muhamed on 2011-06-12