What Is Fistula?

The World Health Organization says that 50,000 to 100,000 women worldwide are affected by obstetric fistula every year and approximately 2 million women around the world (primarily in Asia and sub-Saharan Africa) live with fistula.Fistula is directly linked to one of the four major causes of maternal mortality: obstructed labor.

Imagine a bowling ball suspended in a cloth tube. For hour after hour, the ball is locked in place by solid support structures and it presses, squeezes and rubs against the cloth. This goes on for a long time, maybe even days, until eventually, the ball rubs a hole right through the cloth. Now imagine that ball is a baby’s head and the cloth tube is the skin, muscle and connective tissues of the birth canal and vagina. Instead of descending through the birth canal and being born, the baby is trapped by small pelvic bones or scar tissue or simply because her head isn’t properly positioned. Hours and hours of contractions rub the head against these fragile tissues and pelvic bones, eventually eroding them and creating a hole.

Depending on where the hole develops, it creates an opening to the bladder, rectum or both. The result is, after the mother finally delivers her baby (which is usually dead by this point), she will never fully recover from her birth. Instead, she’ll leak urine or feces uncontrollably through her vagina and she’ll be at high risk for skin and kidney infections and other health complications that can be fatal. She’ll also face social isolation and abuse when her husband, family and community don’t want to live with her odor and incontinence. That is, unless she has access to surgical repair services. Check out our film and see how fistula affected Agnes, a woman we met in Tanzania who lived with her injury for a decade before she was able to have surgery.

The World Health Organization says that 50,000 to 100,000 women worldwide are affected by obstetric fistula every year and approximately 2 million women around the world (primarily in Asia and sub-Saharan Africa) live with fistula. Fistula is directly linked to one of the four major causes of maternal mortality: obstructed labor.

Obstructed labor happens when a mother is too young or small to allow her baby to pass through her birth canal safely. It also occurs when previous childbirth injuries or female genital cutting create scar tissue that’s not flexible enough for childbirth. Obstructed labor occurs in 5% of live births and 8% of maternal deaths and is one of four main causes for maternal morbidity and mortality. In total, for every maternal death there are 20–30 life-changing morbidities (injuries) of which, obstetric fistula is a leader. (WHO)

Most women who experience obstructed labors and fistula live in poor countries, have limited or no access to prenatal care or trained healthcare providers at their deliveries. They’ve lived with poor diet and malnutrition their entire lives, which negatively impacts their growth. In many of these countries, girls marry too young and have babies long before they’re finished growing and their pelvic bones are fully developed. If they have experienced harmful traditional practices such as, Female Genital Cutting (AKA female circumcision) they are also at greater risk. Any one of these factors can contribute to obstructed labor and fistula.

Access to emergency obstetric care is critical for these mothers and their babies. These cases require delivery by C-section, however in a lot of these settings women can’t get a C-section even when critically necessary. In total, the C-section rate in most developing countries is below 5% ,which is significantly lower than the global average. Check out this study, co-authored by Christy Turlington Burns about C-sections, Obstructed Labor and Cost Analysis of Surgical Interventions.

In many societies, the status of girls and women is low and their self-worth is dependent on their ability to have children. In most cases, obstructed labor ends with a stillborn baby. When that occurs in combination with a fistula, it often means divorce, isolation and abuse for the grieving, disfigured and sick mother. If the child survives they are also likely to experience stigmatization related to their birth.

In most cases, fistula is preventable through seemingly simple measures including:

• Eliminating child marriage
• Delaying age of first birth
• Eliminating traditional female cutting
• Access to family planning services
• Access to reproductive health services
• Delivery with a trained birth attendant
• Access to a fully staffed and supplied healthcare facility
• Access to emergency services including C-section

When women have babies as adults and deliver through undamaged vaginas with a trained birth attendant, midwife or obstetrician and have access to emergency services, the incidence of obstructed labor and fistula are drastically reduced. Mothers and babies both survive with their health intact. Achieving these prevention measures however, is complicated and requires woman-to-woman education, diverse cultural and social change, improved infrastructure and healthcare services and a commitment to improve women’s status in society — everything that Every Mother Counts is working to achieve. We know these changes are possible because we’ve seen vast improvements in many areas we visit. The challenge is reaching all areas where women are at high risk for maternal mortality and morbidity.

When fistula can’t be prevented, it can easily be repaired with a simple surgery in 90% of cases. The WHO says that by 2008 over 2000 health professionals were trained in preventing and managing obstetric fistula, but since 2003 only 12,000 women in 45 countries have received obstetric fistula treatment. That’s because not enough women can get to trained health professionals or they’re prevented from accessing care by other financial, social or cultural barriers.

What can you do?

• To learn more about how fistula impacts women’s lives, check out our video here.
• Click on this link to reach our Fistula study guide.
• Donate to Every Mother Counts and every dollar goes to reducing preventable maternal mortality and morbidity and helping women access high-quality health care.

Two other organizations we know are reaching out to women around the world to offer surgical fistula repair and program support that reconnects women with their communities and empowers them with education, job training and even financial investments to start their own businesses.

• Healing Hands of Joy focuses their mission on providing fistula repair and support services to women in Ethiopia. Check out their website and read our accompanying blog about their unique film and fundraising effort (called Film Fights Fistula) to bring fistula prevention education and training programs to communities in need.
• Lake Tanganyika Floating Health Clinic provides essential health services on a floating hospital ship to communities surrounding Lake Tanganyika in Africa. This year, they’re focusing on providing fistula repair surgeries to women from the Congo and Tanzania. Checkout this video about LTFHC’s work.