Obstetric Fistula: A Global Reproductive Health Crisis Issue Summary

Introduction

Obstetric fistula is a childbirth injury with devastating consequences.  Fistula, while virtually unheard of in the United States, occurs when women — most often very young women — give birth and do not have access to quality medical care.  Wealthy countries like the United States can play a positive role in preventing and treating obstetric fistula by supporting access to reproductive health care services in developing countries.

What Is Obstetric Fistula?

Obstetric fistula is an injury that occurs during prolonged or obstructed labor.  Lodged in the birth canal for days, the baby’s head presses against the bladder and/or rectum, causing tissue damage.  The dead tissue eventually falls away, creating one or more holes that leak urine and/or feces uncontrollably (Iyengar & Iyengar, 2004, UNFPA, 2006b).  Fistula can also be caused by unsafe abortion (Bello, 1995).

Young women and girls giving birth are particularly vulnerable to fistula injury because their bodies are less developed and their birth canals are smaller (WHO, 2006).  In many cultures where fistula is prevalent, child marriage and early childbearing are common practices (Bello, 1995, UNFPA 2003).  Malnourished women often also have smaller bodies, which puts them at increased risk (Bello, 1995; Iyengar & Iyengar, 2004).  However, older women may be in danger of fistula as well, particularly if they do not have access to family planning services.  A constant cycle of pregnancy and breastfeeding leaves these women with soft bones, making them susceptible (Iyengar & Iyengar, 2004).

Virtually Eradicated from the U.S., Common Among the Poorest of the Poor

Fistula commonly occurred in the United States until the 19^th century (UNFPA, 2006a), when modern technology and medical advances made it virtually obsolete.  Today, obstetric fistula still plagues women in developing countries, where there is limited access to obstetric care.  The World Health Organization estimates that more than two million women in developing countries are living with untreated fistula — and that number increases by 50,000–100,000 each year (WHO, 2006). 

Fistula is particularly prevalent in sub-Saharan Africa and parts of southern Asia (WHO, 2006); impoverished women in rural areas are most at risk (Bello, 1995, Iyengar & Iyengar, 2004).  Often, their births are unattended by a health care professional — and when they need emergency obstetrical care they are deterred by lack of transportation and lack of funds (Bello, 1995; Iyengar & Iyengar, 2004).  Often, the closest hospital is too far away.  In many regions where fistula is rampant, health care systems are weak, and hospitals lack equipment and resources (WHO, 2006; UNFPA, 2003).

Implications of Fistula

Fistula is a devastating injury — physically, emotionally, and socially.  The baby usually dies and the woman is left with chronic incontinence.  The prolonged labor associated with fistula is also linked to multiple birth-related injuries such as organ failure, infertility, neurological injuries, and even early death (Bello, 1995; Iyengar & Iyengar, 2004; UNFPA, 2004).  The social consequences are also severe:  women suffering from fistula are often abandoned or divorced by their husbands, unable to work, and ostracized by their communities (Bello, 1995; Iyengar & Iyengar, 2004; UNFPA, 2004).

Fistula Is Preventable and Treatable

The real tragedy is that fistula can be easily prevented.  Improved access to education and family planning services enables young women and girls to postpone pregnancy until they are physically mature, and older women to space the births of their children.  Improved nutrition strengthens a woman’s physical ability to give birth and reduces risks of complications.  Education for men as well as women, and other strategies to address early marriage also contribute to fistula prevention (UNFPA, 2006a; UNFPA, 2006b).

The physical damage of fistula can be repaired through reconstructive surgery, which has a success rate of up to 90 percent for uncomplicated cases (UNFPA, 2006b).  The average cost of these surgeries plus rehabilitation is $300 — far beyond the resources of many women suffering from fistula (Bello, 1995; UNFPA, 2006c).  Women also need counseling to address the emotional damage of the injury (UNFPA, 2006a).  Unfortunately, the need for help far exceeds available services.

Policy Advances

U.S. funding for family planning programs in the world’s poorest countries could help prevent thousands of fistula injuries each year.  However, as the U.S. shirks its commitment to international family planning, it delays progress on issues like fistula.  Instead of working to eliminate this tragedy, our policies leave women and families stranded.

In 1994, the United States and 178 other countries vowed to provide universal reproductive health care by 2015 — including family planning, prevention of sexually transmitted infections, and assisted childbirth — to lower the incidence of fistula and other health risks (UNFPA, 2003; Kaisernetwork, 2005).  More than a decade later, the U.S. has backed off on this commitment.  For the last four years, President Bush has blocked the funds approved by Congress for UNFPA’s family planning services (Guttmacher Institute, 2005).  And since reinstating the global gag rule on his first day in office, family planning supplies and services around the world have dwindled (Access Denied, 2006).

There is some good news.  In 2003, UNFPA and partner organizations launched the global Campaign to End Fistula.  The campaign is fighting fistula on three fronts:  prevention, treatment, and support for women after surgery (UNFPA, 2006b).  The campaign is now active in more than 35 developing countries in Africa, Asia, and the Arab region (UNFPA, 2006c).

But there is more to be done.  Fistula can be eliminated — but prevention is the key.  Family planning and education are essential.  Each year that the U.S. denies urgently needed funds for international reproductive health, women, families, and communities suffer.  The U.S. must support initiatives for family planning and repeal the global gag rule to save women and children around the world.

Cited References

Access Denied.  (2006, accessed 2006, August 1).  “The Impact of the Global Gag Rule in Nepal.”  [Online].  http://www.globalgagrule.org/pdfs/case_studies/GGRcase_nepal.pdf

Bello, Kikelomo.  (1995).  “Vesicovaginal Fistula (VVF):  Only to a Woman Accursed” in Janet Hatcher Roberts and Carol Vlassoff, eds. Ottowa: International Research Development Center. The Female Client and the Health-Care Provider.  http://www.idrc.ca/en/ev-283282-201-1-DO_TOPIC.html

Guttmacher Institute.  (2005, September 18, accessed 2006, September 26).  “Bush Administration Withholds UNFPA Funding for Fourth Year.”  [Online].  http://www.guttmacher.org/media/inthenews/2005/09/18/index.html

Iyengar, Kirti & Sharad D. Iyengar.  (2004).  “Research Needs in Maternal Morbidity.”  Paper presented at the Global Forum for Health Research, Forum 8, Mexico City, November 2004.

Kaisernetwork.org.  (2004, August 27, accessed 2006, June 30).  “International News:  London Meeting Marking Cairo Conference Anniversary to Assess Impact of U.S. Withholding Family Planning Funds”.  [Online].  http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=25472.

UNFPA — United Nations Population Fund.  (2006a, accessed 2006, June 16).  Fast Facts: Fistula and Reproductive Health.

_____.  (2006b, accessed 2006, September 26).  “Campaign to End Fistula:  Frequently Asked Questions.”  [Online].  http://www.endfistula.org/q_a.htm

_____.  (2006c, accessed 2006, September 27).  “Campaign to End Fistula:  The Campaign in Brief.”  [Online].  http://www.endfistula.org/campaign_brief.htm

_____.  (2004, accessed 2006, September 26).  The Campaign to End Fistula:  The Challenge of Living with Fistula. (2004).  [Online].  http://www.endfistula.org/living_with_fistula.htm

_____.  (2003, accessed 2006, September 26).  South Asia Conference for the Prevention & Treatment of Obstetric Fistula.  Presented at conference in Dhaka, Bangladesh Dec. 9-11, 2003.

WHO — World Health Organization.  (2006, accessed 2006, September 26).  Obstetric Fistula:  Guiding Principles for Clinical Management and Programme Development.

Published: 11.02.06 | Updated: 11.02.06

Published by International Division, Planned Parenthood^® Federation of America

©2006 Planned Parenthood^® Federation of America, Inc.
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