By Nadia Khan
30 October 2008 [MEDIAGLOBAL]: Obstetric fistula, a condition caused by prolonged childbirth without medical intervention, leaves 50,000 to 100,000 women with a hole in their birth canal each year. In addition to suffering from incontinence, these women face social ostracism and cultural backlash.
“Reactions and levels of support from family members and husbands varied by country and across assessments,” Christina Vrachnos of the United Nations Population Fund, explained to MediaGlobal, as obstetric fistula effects women across African, Asian and Arab regions.
Reports range from women being rejected by their husbands and isolated from their families and communities to some women still receiving support from their husbands.
“Women reported being physically isolated from their families in West Darfur and mistreated by in-laws in Burkina Faso,” Vrachnos said. However, “more than half of the 71 women living with fistula interviewed in the Central African Republic indicated that their husbands provided moral and financial support.”
Six fistula survivors who spoke at Women Deliver, a conference on maternal death and disability in London. (Photo: David Rose/Panos/UNFPA)
Unfortunately, while the condition is both preventable and treatable, many of the women living with fistula believe that it is the will of God or a punishment from God, and inflict repercussions upon themselves.
“Women told of living on the margins of society due to their own self-imposed isolation because of the smell [of urine], embarrassment and fear of ostracism from the community,” Vrachnos explained. “Women also spoke of their inability to practice any type of economic activity and hence their financial dependence on others.”
The incontinence caused by fistula, is the source of most of the negative reactions against women living with the condition regardless of location or culture. “Some women in Mali were excluded from religious activities as they were perceived as unclean. Fistula patients in Bangladesh described being given less priority for admission due to limited beds and reproach related to the smell of urine,” described Vrachnos.
The worst part about obstetric fistula for women is that it is almost entirely treatable, and these women do not have access to treatment or are unaware of its existence.
“Reconstructive surgery can mend the injury, and success rates are as high as 90 per cent for uncomplicated cases,” said Vrachnos. While two weeks of post-operative care is required, the average cost still remains around US$300.
“If surgery is successful, women can resume full and productive lives. They can usually have more children, but Caesarean sections are recommended to prevent a recurrence of fistula.”
There are also still options for women when surgery cannot correct the condition, or is unsuccessful. “Women [can] undergo a procedure called a urostomy, and they wear a bag to collect their urine,” explained Vrachnos.
To aid these women, UNFPA began their Campaign to End Obstetric Fistula in 2003, with the goal of eradicating obstetric fistula by 2015. “During treatment campaigns, UNFPA often covers the cost of surgical treatment for women,” explained Vrachnos about the programs. “In many locations, the cost of care is subsidized or covered in full.”
Aside from providing medical care and support, UNFPA works with other organizations to help women with fistula and recovering from fistula reintegrate into society and get back to the lives they had before fistula.
“Rehabilitation focuses primarily on rebuilding women’s self-esteem and feelings of self-worth through socio-economic empowerment, as well as literacy or vocational training, psychosocial counseling services, and health education to promote health-seeking behavior,” Vrachnos said of UNFPA’s rehabilitation services.
A great component of UNFPA’s campaign is their use of the media to educate the world about the obstetric fistula, raise awareness about its causes and treatments, and possible policy changes that are needed to protect women from suffering from the condition. Moreover, the media is used to promote messages about the importance of maternal health care, family planning and information on reproductive rights.
“Increasingly, the Campaign is relying on the first-person perspective of fistula advocates – strong, powerful women who draw on their personal experiences – to convince communities and policy makers of the right to treatment and the importance of preventing maternal death and disability,” Vrachnos said.
As a result of the work of UNFPA and other committed organizations around the world, eliminating obstetric fistula by 2015 is becoming an achievable goal. So far, in the last five years, UNFPA’s programs have helped almost 7800 women with obstetric fistula.