New map reveals Africa's hidden pregnancy problem

Posted: 19 June 2003

The first report ever to map obstetric fistula in sub-Saharan Africa was launched today by the United Nations Population Fund (UNFPA) and EngenderHealth.

Obstetric fistula, a debilitating pregnancy-related condition caused by prolonged obstructed labour, leaves women constantly leaking urine and/or faeces. The new report indicates that current figures on the number of women living with fistula - estimated at 2 million - are too low, since they are based on patients who seek treatment in medical facilities. In Nigeria alone, there could be as many as 1 million women living with fistula, the report says.

“We hope this report will sound a global alarm about fistula,” said Thoraya Ahmed Obaid, UNFPA Executive Director. “Most women living with fistula today suffer in silence, unaware that a simple cure is available. These women deserve our immediate attention. That is why UNFPA has launched a global campaign to prevent and treat fistula.”

The new report, Obstetric Fistula Needs Assessment: Findings from Nine African Countries, shows that many fistula sufferers are abandoned by their husbands, forced out of their homes, ostracized by family and friends and even disdained by health workers, who consider them ‘unclean’. Without skills to earn a living, some have no choice but to beg or turn to sex work to survive. Women living with fistula in sub-Saharan Africa are usually under 20 (some as young as 13), illiterate and poor, according to the findings.

“Women with fistula are living indicators of failed maternal health systems,” said Dr. Amy Pollack, President of EngenderHealth. “Almost all women who develop fistula attempt to deliver their babies at home without skilled medical care. These women remain in labour for many days and the baby usually dies. No one is there to help them.”

The report assesses the capacity of 35 hospitals in nine countries to treat patients and outlines their needs for equipment, skilled medical staff and surgical supplies. In many countries, doctors are unable to meet the demand for care. The report highlights the need to train more local doctors in fistula surgery and points to a heavy reliance on visiting, volunteer surgeons. In Uganda, one visiting doctor worked day and night, but could only operate on 20 of the 200 women who came for treatment before he had to leave.

Fistula is both preventable and treatable and is virtually unknown in places where early pregnancy is discouraged, young women are educated, family planning is accessible and skilled medical care is provided at childbirth.

About Obstetric Fistula

Fistula usually occurs when a woman is in obstructed labour for days on end without medical help and cannot get a Caesarean section. The prolonged pressure of the baby’s head against the mother’s pelvis cuts off the blood supply to the soft tissues surrounding her bladder, rectum and vagina. The injured tissue soon rots away, leaving a hole, or fistula. If the hole is between the woman’s vagina and bladder, she loses control over her urination, and if it is between her vagina and rectum, she loses control of her bowels. Reconstructive surgery can mend this injury. Most women are either unaware that treatment is available, or cannot access or afford it. Fistula surgical repair has up to 90 per cent success rates and costs between $100-$400.

Related links:

  • Read the report: Obstetric Fistula Needs Assessment: Findings from Nine African Countries
  • UNFPA

  • EngenderHealth