Sunday, 16 December 2012

Obstetric Fistulae

While much attention has been paid to the socio-economic plight of women in developing countries, the media often neglects to highlight the physical ramifications of such environments, especially regarding women’s health. Poverty and low status are not only psychologically debilitating, but can have severe medical consequences. While an unsexy issue, and therefore one that is difficult to publicize, a lack of adequate medical care is a dangerous (and potentially fatal) problem for women worldwide.

One such issue, remarkably simple and yet devastating, is a birth complication known as obstetric fistula. In regions such as sub-Saharan Africa and parts of Asia, where many women do not receive pre-natal care, this easily preventable and treatable condition affects up to 50,000 women each year.

Obstetric fistula occurs during obstructed labour, when the baby’s head pushes against the pelvic bone, cutting off blood supply to the surrounding tissue.  This creates a ‘fistula’, or a hole, between the birth canal and the nearby internal organs. Among these are the bladder and bowel, which, when affected, can rob the woman the ability to hold her urine or her faeces, an embarrassing and debilitating condition. The physical pain and psychological effects are profound enough, but even worse is the stigma attached to it. Because of the physical incapacitation and foul smell, many individuals are shunned by their communities or exiled from their families. In some cultures, it is not seen as a medical problem, but divine punishment for misbehaviour and in others, women lose their worth when unable to bear children.

In pain and alone without the resources for treatment, women can suffer for years in physical and psychological agony. Relating her story, a Ugandan woman, Sifa, explains how she endured days of labour and a miscarriage after her family refused to take her to a hospital for delivery. “I started leaking urine like tap water after that. I suffered a lot during that time. My husband left me. My mother hated me. I couldn’t fit in with people.” Sifa eventually managed to find herself at a hospital, where she made a full recovery after treatment. However, not all women are as lucky as Sifa.

The treatment for fistula is surgery – estimated at a cost of USD $450 for an individual, it is a relatively low cost procedure that can make or break a life. Recognized as one of the most widespread problems in women’s health, treatment of obstetric fistula was included in the Millennium Development Goals established in 2000, and the UNFPA has begun a campaign directly geared towards ending obstetric fistula.

While the direct cause of fistula is indeed a prolonged labour, an indirect cause is the poverty in many of these countries. The condition has been practically eliminated in the developed world, because of the availability of C-sections and high level of prenatal care. In poorer countries, however, a variety of factors contribute to this growing problem. Malnourishment during growth causes many women to be ill-equipped for childbirth, as their bodies are stunted and pelvises tend to be underdeveloped. Lack of education means many women are unaware of the risks of a prolonged labour. Inability to access adequate healthcare because of cost, distance or in some cases, a woman’s lack of agency over her own body, are all obstacles in caring for high-risk individuals.

Currently, there are a variety of organizations established to educate and eradicate obstetric fitula. You can learn more or how to help at the websites below:

Farahnaz Mohammed

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