USA/Africa Dialogue, No 678: Women's Health

A little known campaign to prevent crippling childbirth injuries could spare tens of thousands of women each year from incapacitating health problems and social ostracism caused by obstetric fistula.

"It is better to be blind than have fistula," said one young woman. "...at least people help you." Fistula - now unknown to most people in the western world - is an entirely preventable medical and social tragedy. Caused by complications during childbirth, when emergency obstetric care is not available, the condition results in long-term, chronic incontinence and can lead to kidney disease and even death. Damage to the nerves in the legs leaves some women unable to walk. In 95 per cent of cases, the baby dies. Without treatment, prospects for work and family life are greatly diminished. Women suffering from fistulas are ostracized by their communities and abandoned by their families. Many become beggars and eventually die from untreated infections.

The World Health Organization (WHO) estimates that more than two million women are living with fistula in developing countries and that an additional 50,000 to 100,000 new cases occur each year. Doctors campaigning to bring the dimensions of fistula to world attention say it could be prevented if young girls married later, had adequate medical care during pregnancy and received emergency obstetric care if they developed complications. In developing countries however, only 58 per cent of women deliver their babies with the assistance of a professional midwife or doctor and only 40 per cent give birth in a hospital or health centre.

"Obstetric fistula is a double sorrow because women lose their babies and they lose their dignity," says Thoraya Ahmed Obaid, Executive Director of United Nations Population Fund (UNFPA). "UNFPA hopes that the Global Campaign to End Fistula will eventually make fistula as rare in Africa and Asia as it is in other parts of the world."

At risk are women living in remote rural areas with little access to medical care.
A Global Campaign to End Fistula, launched two years ago by UNFPA and global partners, is able to provide only partial support to about 30 countries, mostly in sub-Saharan Africa.
It costs only $300 to restore the health and dignity of a woman suffering from fistula, but that's way beyond the means of people in countries where annual income is much less than that.
In February 2005, the Global Campaign and the Nigerian government supported restorative surgery for 545 women in just two weeks. Nigeria may have as many as 800,000 women with fistula.
If current demand for family planning services in developing countries was were met, maternal deaths and injuries could be reduced by 20 per cent or more.
Fistula has been eliminated in Europe and North America through improved obstetric care.