Reducing Obstetric Fistula: Improving Physical, Social and Economic Strains on Women

Rebecca Shore

JHU∙CCP | Online Communications Manager


© 2008 Micah Albert, Courtesy of Photoshare

It is unacceptable that women and girls in developing countries are still suffering from fistula,” says Dr. Anicet Nzabonimpa, the Family Planning and HIV integration coordinator in the Rwandan Ministry of Health (MOH). Obstetric fistula is a devastating medical condition in which the pressure of unrelieved labor creates an opening between the vagina and the bladder or rectum. Approximately 50,000 to 100,000 women per year are afflicted—mostly in developing countries. In recent news, the Ministry of Health and United Nations Population Fund (UNFPA) in Rwanda made a commitment to end obstetric fistula. Measures such as these at the high level increase attention to this serious issue. Greater awareness of the problem is the first step in reducing the incidence of fistula, improving access to prevention and treatment, and returning a woman’s ability to fully participate as a mother, wife, and member of her community. 

The medical and social implications of fistula make this issue extremely important. Continuous incontinence makes normal life a struggle, and women with fistula may also suffer from recurring infections, paralysis in the lower legs, and infertility. To make matters worse, many afflicted women also find themselves divorced or abandoned. Obstetric fistula affects a woman on all levels: physically, socially, emotionally, and economically. In many cases, when labor is obstructed, the child dies before it is born, causing intense and lasting emotional pain in the mother—which is often compounded by divorce and social stigma. On a personal level, an obstructed labor with resultant fistula can turn a productive contributor to her community into a wounded soul, mourning the loss of her child and possibly the loss of her marriage. She may also be left destitute and incapable of working. 

Fistula is usually the result of the lack of surgical measures during prolonged obstructed labor. This is most likely where pregnant women do not have access to emergency obstetrics care. Young mothers—those in their teens, whose pelvises are not fully formed—are also at increased risk. So in communities where early pregnancy and lack of birth attendants is the norm, fistula is particularly common. It is important to understand that advances in medicine can prevent obstetric fistula, and repair fistulas that do occur. 

UNFPA Deputy Representative, Mr. Cheikh Fall, notes that obstetric fistula does not just affect women—it affects nations. “Women are over 50% of Rwanda’s population, we cannot attain development without their participation”, he says—but fistula deprives women of the opportunity to contribute to the life of their community and the development of their nation.

Successful programs to prevent and treat obstetric fistula must address the myriad of issues surrounding this medical condition. Access to quality maternal and emergency obstetric care and reducing child marriage can prevent obstetric fistulas before they even occur. Rapid treatment, counseling and support for the mother, education and outreach to fathers and the community, and reintegration programs for recovering women can reduce the devastation of fistulas that do occur. 

For more information on Obstetric Fistula, take a look at the INFO report, Obstetric Fistula: Ending the silence, easing the suffering.

Rebecca Shore is a Communications Specialist for the Knowledge for Health Project. She is a regular contributor to K4Health’s blog, including this monthly series “Women of the World: Focusing on Empowerment, Health and Human Rights."