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KEY POINTS
Obstetric fistula—a devastating medical condition consisting of an abnormal opening between the vagina and the bladder or rectum—results from unrelieved obstructed labor: Unless the fetus is delivered surgically, prolonged obstructed labor often ends only when the fetus dies, decomposes, and is finally passed from the mother. In many cases the mother’s injured pelvic tissue breaks down, leaving a hole, or fistula, between adjacent organs. Fistulas also can have nonobstetric causes, such as laceration or sexual trauma (see Fistula Afflicts Millions in Developing Countries).
Fistulas can have terrible social consequences: The physical consequences of a fistula—including the continuous leaking of urine, feces, or both—usually make a normal life difficult, if not impossible. Fistula patients are often shunned, abandoned, or divorced (see Consequences Often Severe).
Fistulas occur most where health care is least available: Fistula afflicts millions of women in developing countries. It is most common among the poor in rural sub-Saharan Africa and South Asia. Many women who develop obstetric fistulas have given birth at home, often without skilled attendants or prompt access to emergency obstetric care. Fistula can occur at any age but is more common among young women, whose pelvises have not fully developed. While most fistulas can be repaired with surgery, limited access to repair facilities and trained providers, as well as inadequate information on fistula repair, keeps women from the help they need (see Fistula Most Common Where Good Obstetric Care Is Lacking).
A comprehensive approach works best: The problems of fistula, both medical and social, are likely to persist until better health care reaches the poorest and most vulnerable members of society. Three elements form the core of a comprehensive approach to helping women and their families (see Taking a Comprehensive Approach):
- Reducing the number of adolescent pregnancies by encouraging later marriage and expanding access to family planning services;
- Improving access to good obstetric care, including emergency care;
- Providing surgical treatment and counseling to women living with fistula.
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