Preventing and Treating Fistula

Obstetric fistula is a preventable and treatable condition. Causes include childbearing at too early an age, poverty, malnutrition, lack of education and limited access to emergency obstetric care. Prevalence is highest in impoverished communities in Africa--particularly sub-Saharan Africa--and Asia.

About 15 per cent of all pregnancies result in complications that require emergency medical intervention. Fistulas tend to occur as a result of three classic delays in getting appropriate treatment:

• a delay in the decision to seek medical attention;
• a delay in reaching a health care facility;
• a delay in receiving emergency obstetric care at the facility.

The World Health Organization estimates that over two million women are living with obstetric fistulas today. Estimates are based on the number of people who seek treatment in hospitals and clinics and are therefore likely to be grossly underestimated. Most young women suffer in silence.

Fortunately, most fistulas can be corrected surgically, even after several years. The cost ranges from $100-$400, but this amount is far beyond what most patients can afford. If done properly, surgical repair can have a success rate as high as 90 per cent and women can usually have more children. Attentive post-operative care, for a minimum of 10-14 days, is critical to prevent infection while the surgery heals. Education and counselling are also needed to help restore the young woman’s self-esteem and allow her to reintegrate into her community once she is healed.

Fistula was once common throughout the world, but has been eradicated in areas such as Europe and North America through improved obstetric care. Obstetric fistulas are virtually unknown in places where early marriage is discouraged, young women are educated about their bodies and skilled medical care is provided at childbirth.

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