Although obstetric fistula may not be as widely recognized as other maternal health issues, the Fistula Foundation estimates that over two million women and girls in developing countries suffer from this condition today. The World Health Organization has labeled it as “the single most dramatic aftermath of neglected childbirth
Obstetric fistula is a devastating condition
often resulting from obstructed labor that can cause infections, incontinence, and even paralysis. The condition largely afflicts poor, rural, and illiterate women in developing countries who lack resources and access to emergency care and surgery, and sufferers often face an additional burden of social stigma.
Economic Development and Social Standing
Poor infrastructure and poverty significantly increases the occurrence rate of obstetric fistula. Lewis Wall, in an article for The Lancet, writes that “poverty is the breeding-ground where obstetric fistulas thrive.” Wall cites early marriage, low social status of women, malnutrition, inadequately developed social and economic infrastructures, and lack of access to emergency obstetric services as being major contributors of fistulas in developing countries.
Additionally, “postponing the age of marriage and delaying childbirth can significantly reduce the risk of subjecting young women to the arduous labor that induces fistulas,” wrote Sonny Inbaraj of Inter Press Service News Agency (IPS) in an article about how fistula makes social outcasts of child brides.
In most developing societies where child marriage is common, the social standing of women is defined largely in terms of marriage and childbearing. Child marriages are typically arranged without the knowledge or consent of the girls involved. The norms emphasize a girl’s domestic roles and de-emphasize investments such as education.
Stigmatization of Fistula
There is an undeniable link between fistula and social stigmatization. Rather than receiving assistance from their families and communities, women are often ostracized and in many instances exiled from their communities. This is especially true in developing countries where “the role of women is merely limited to providing sexual satisfaction for their husbands, [and] producing children,” said Dr. Catherine Hamlin, founder of the Addis Ababa Fistula Hospital, in an interview with IPS.
“Many women and girls with fistula endure lives of shame, misery, violence, and poverty,” said Agnes Odhiambo, Africa women’s rights researcher and author of ‘I Am Not Dead, But I Am Not Living‘: Barriers to Fistula Prevention and Treatment in Kenya, in a Human Rights Watch article. Human Rights Watch has focused on fistula, recognizing that birth is a human rights issue. Ignoring the issues of women and girls only diminishes progress on human rights and sends a message that says the rights of women do not deserve adequate attention.
Thus far the fight to end fistula has attracted various government agencies and organizations including USAID, UNFPA, EngenderHealth, Maternal Health Task Force, and the Human Rights Watch. Outstanding individuals have also played a key role in fistula prevention efforts, like Drs. Reginald and Catherine Hamlin, Australian gynecologists who came to Addis Ababa in 1959 for temporary medical work, but after hearing heart-breaking stories from fistula patients, they decided to move to Ethiopia permanently and open the Addis Ababa Fistula Hospital. As the only hospital dedicated exclusively to women with obstetric fistula, the hospital provides care free of change, and has done so since 1974.
Although fistula has gotten some support and attention, the need to scale-up the prevention initiatives has never been greater. As a result of the “poverty and the stigma associated with their condition, most women living with fistulas remain invisible to policy makers both in their own countries and abroad,” wrote Inbaraj on IPS.
“Preventing fistula and restoring women’s health and dignity requires more than good policies on paper,” said Odhiambo at Human Rights Watch. Seriously tackling the issue will require much more than traditional medical and public health interventions – prevention efforts must also take into account underlying social issues, food and economic security.
Sources: The Addis Ababa Fistula Hospital, Campaign to End Fistula, The Center for Global Development, The Fistula Foundation, Human Rights Watch, The Lancet, World Health Organization.
Photo Credit: “Hauwa’u, 25, mother from Rogogo community,” courtesy of flicker user DFID-UK Department for International Development.