New drive to tackle stigma of fistula

Posted: 15 December 2003

Obstetric fistula, the most devastating of all pregnancy-related disabilities, affects hundreds of thousands of girls and women in South Asia. In Bangladesh alone, over 400,000 women are estimated to be living with the condition. Now the UN Population Fund is leading a campaign to end this hidden catastrophe.

The Bangladeshi figure was revealed in a study issued at the first South Asia Conference for the Prevention and Treatment of Fistula, held in Dhaka, Bangladesh in December 2003, organised by UNFPA.

The Fund will help the Bangladesh Government establish a National Fistula Centre that will eventually serve as a Centre of Excellence in South Asia to manage fistula cases and train service providers.

Obstetric fistula occurs when a woman has a prolonged, obstructed labour and cannot get medical help. The constant pressure of the baby's head in the birth canal causes a hole to form between the woman's bladder and vagina and/or rectum. In nearly every case, the baby dies. The mother is left with constant leaking of urine and/or faeces.

The social consequences of fistula are disastrous for the sufferer. Women are often rejected by their husbands, shunned by their communities and blamed for their condition. Reliable data on fistula are scarce, but it is estimated that at least two million women are living with the condition in Africa and South Asia. "The lack of good statistics indicates the nature of the problem," said Dr. Nafis Sadik, UNFPA Special Ambassador on Fistula. "It affects the poor, the young and the female. Fistula has no priority at all on national health policy agendas. We are here to change that."

Prevention and cure

Fistula is both preventable, and treatable through surgery. Experts acknowledged that fistula is associated with poverty, poor medical services and social discrimination against women. They identified methods to prevent fistula, including:

  • Delaying the age at first pregnancy, since women under age 20 are more prone to obstruction during labour and run a greater risk of dying during childbirth
  • Providing access to family planning to help women plan and space births;

  • Improving access to pre-natal care for all pregnant women

  • Providing skilled attendance at childbirth to help detect complications and refer women to a hospital when necessary

  • Providing affordable and accessible emergency obstetric care to help women get medical help, such as Caesarean sections, when needed.
There is a huge need for treatment for women living with fistula. This will call for sites where surgery can be performed, and surgeons trained to operate on women to repair the damage. and rehabilitate patiernts. In October, 2003, UNFPA sponsored fistula surgeons from Ethiopia and Australia to train 20 local doctors and nurses in Bangladesh.

The long-term goal of the fistula campaign is to make fistula as rare in Africa and Asia as it is in industrialized countries today. The campaign is currently providing support to more than 20 countries.

For more information, visit: UNFPA