Fistula...

Fistula used to be present in the U.S. and Europe, but was largely eliminated in the latter part of the 19th century and early 20th century with improved obstetric care in general and the use of c-sections in particular to relieve obstructed labor.

The World Health Organization estimates that approximately 2 million women have untreated fistula and that approximately 100,000 women develop fistula each year. Fistula is most prevalent in sub-Saharan Africa and Asia.

In Ethiopia, alone, there are an estimated 100,000 women suffering with untreated fistula, and another 9,000 women who develop fistula each year.

Less than 6 in 10 women in developing countries give birth with any trained professional, such as a midwife or a doctor. In Ethiopia, only 1 in 10 women have a trained attendant. When complications arise, as they do in approximately 15% of all births, there is no one available to treat the woman, leading to disabling injuries like fistula, and even death.

The root causes of fistula are grinding poverty and the low status of women and girls. In Ethiopia, the poverty and malnutrition in children contributes to the condition of stunting, where the girl skeleton, and therefore pelvis as well, do not fully mature. This stunted condition can contribute to obstructed labor, and therefore fistula.

But, fistula is both preventable and treatable. The Addis Ababa Fistula Hospital has treated over 30,000 women over 33 years. Their cure rate is over 90%. Fistula can be prevented if laboring women are provided with adequate emergency obstetric care when complications arise.


Q & A : Fistula


Q:
Can fistula be "cured"?
A:
Yes. An obstetric fistula can be closed with intravaginal surgery. If her surgery is performed by a skilled surgeon, a fistula patient has a good chance of returning to a normal life with full control of her bodily functions. The Fistula Hospital has a 93% success/cure rate.

Q:
How much does it cost to treat a fistula?
A:
At the Hamlin Fistula Hospitals, it costs US$450 to provide one woman with a fistula repair operation, high-quality postoperative care, a new dress, and bus fare home.

Q:
What are the causes of obstetric fistula?
A:
A fistula results from an obstructed labor that is left unrelieved and untreated. It is estimated that 5% of all pregnant women worldwide will experience obstructed labor. In the United States and other affluent countries, emergency obstetric care is readily available. In many developing countries where there are few hospitals, few doctors, and poor transportation systems, and where women are not highly valued, obstructed labor often results in death of the mother. When she survives, there is a great likelihood her child will die and she will develop a fistula. According to the United Nations Population Fund (UNFPA), there are three delays that contribute to the development of a fistula: delay in seeking medical attention; delay in reaching a medical facility; and delay in receiving medical care once arriving at a health care facility.

Q:
I heard that fistulas are a result of female genital mutilation. Is this true?
A:
While harmful traditional practices such as female genital mutilation (FGM) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients at the Hamlin Fistula Hospitals have been victims of FGM, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGM does not "cause" a fistula.

Q:
How many women does this problem affect?
A:
Because fistula affects women in the most remote regions of the world, an accurate count is very hard to achieve. The most common estimate is that 100,000 women worldwide develop fistulas every year, though some estimates put the number closer to 500,000. Experts at the Hamlin Fistula Hospitals estimate that there are approximately 9,000 new cases of fistula every year in Ethiopia alone. Because most fistula sufferers are young women—many still in their teens—they are likely to live with their condition for upwards of 25 years. By any estimate, there are at least two million women currently living with fistula throughout the developing world. The world capacity to treat fistula is estimated at 6,500 fistula repair surgeries per year.

Q:
Where is fistula prevalent?
A:
There is a high incidence of fistula in Africa and parts of Asia, but women are susceptible to developing fistulas wherever there are insufficient emergency obstetric care systems.

Q:
Can fistula be prevented?
A:
Any woman who can gain access to emergency obstetric care such as a cesarean section will not develop a fistula. This is why Hamlin Fistula Hospitals are building new small hospitals in five Ethiopian provinces to increase the capacity of regional hospitals to provide fistula repair surgery and quality emergency obstetric care.