International Day to End Obstetric Fistula

Elizabeth Romanoff Silva


May 23rd marked the International Day to End Obstetric Fistula. This year’s theme “End fistula, restore women’s dignity,” emphasizes that high rates of fistula continue to debilitate women and girls and deny them equal opportunities around the world.

Obstetric fistula is one of the most serious injuries that can occur during childbirth and happens when a woman or girl experiences prolonged and obstructed labor. The compression of the baby's head against the mother's birth canal can cause the baby to die and can destroy the tissue separating a woman's reproductive and excretory systems. As the result, a hole (fistula) between the birth canal and the bladder or rectum is created. Obstetric fistula leads women and girls to be incontinent, and as a result, they are often stigmatized in their families and communities. Yet obstetric fistula is almost completely preventable and treatable.

While there is a very effective surgical procedure to repair the fistula, lack of awareness, funding and treatment capacity keep people, particularly those living below the poverty line, from getting this live-saving care.  It’s estimated that about 2 million women and girls globally are living with the effects of fistula, with the highest rates in sub-Saharan Africa and Asia.

One factor that contributes to a higher likelihood of a mother-to-be having obstructed labor is if that mother is a child herself. Young girls’ bodies are often not fully developed to go through pregnancy and childbirth without complications. Adolescent mothers are more likely to experience adverse events, including a higher risk of obstructed labor, than women in their twenties. According to the WHO, research in Ethiopia and Nigeria found that more than 25% of fistula patients became pregnant before the age of 15, with more than half of all patients becoming pregnant before the age of 18.

Two effective ways to respond to the specific needs of adolescent girls to prevent and mitigate the impact of obstetric fistula are to:
1)    Implement programs to combat child marriage and prevent adolescent girls from becoming pregnant before they are 18 and before their bodies are fully developed and ready to bear children, and
2)    Improve access to antenatal care (ANC) services and emergency obstetric care, with a specific focus on adolescent girls. Data on the age of pregnant females who access ANC services should also be collected, and a special focus should be placed on ensuring young mothers deliver in a facility which is equipped to perform cesarean surgeries in the case of an obstructed labor.

Through the USAID ASSIST Project, we use improvement methods to support teams to prevent and respond to child marriage in Kenya, Malawi and Uganda through orphans and vulnerable children services.  ASSIST supports improved access to high quality maternal and newborn care services in Mali, Uganda, Kenya, Tanzania, Burundi, and Lesotho. Our approach to address gender issues in our improvement work involves identifying the gender-related factors leading to poorer outcomes and responding strategically and holistically throughout the program cycle.

Learn more about USAID’s response to obstetric fistula.

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