Obstetric Fistula

Obstetric fistula refers to an abnormal opening between adjacent structures in the pelvis, resulting from the compression of soft tissues by the baby's head during arrested labor, particularly during the second or “pushing” stage. Obstetric fistula is almost unheard of in the developed world, because arrested descent of the fetal head is commonly relieved by performing a widely available surgery, Caesarean section. Some experts have estimated that over 3 million women suffer from obstetric fistula. Obstetric fistula is a complicated global health problem in terms of its consequences, risk factors, treatment, and prevention.

Types of obstetric fistula include vesicovaginal fistula (between the bladder and the vagina) and rectovaginal fistula (between the rectum and the vagina) among others. It is also possible for a woman to develop a combination of several types of fistula and to experience related injury to muscles, nerves, and/or skin.

However, it is injury to social relationships that may carry the greatest risk of harm to women globally. Women with severe urinary and/or fecal incontinence and the related odor resulting from fistulae commonly struggle with problems such as rejection by family members, homelessness, social isolation, depression, divorce, poverty, malnutrition, and even early death. Some cultures believe that a difficult labor and delivery is a divine punishment for immoral behavior, making it difficult for women with fistulae to ask for and receive help.

Several different factors may put women at risk for the development of fistulae. Cultural practices supporting the early marriage of girl children contribute to higher rates of fistulae, as do malnutrition and low socioeconomic status of women in the developing world. Areas where skilled labor attendants are lacking and obstetric services may be limited or remote tend to have higher rates as well.

Surgical repair may be costly and difficult, depending on the extent of damage to body tissues. Even after fistula repair, many women still have some incontinence. The Addis Ababa Fistula Hospital is a large specialty center in Africa devoted to care for fistula patients, and is considered a model for this type of institution. Experts believe that prevention of obstetric fistulae will require the attention of public and private partners to this complex problem rooted in gender inequality, economic disadvantage, and inadequate healthcare infrastructure in the developing world.