Credits: WHO/P. Virot
“Taking action means saying ‘no’ to indifference… It is a choice: whether or not to support a woman, whether or not to protect her, whether or not to defend her rights”
Dr. Denis Mukwege
Each year between 50,000 and 100,000 women and girls worldwide are affected by obstetric fistula, resulting in an estimated 2-3 million women currently living with the condition. Fistula presents a burden in nearly 60 countries, almost exclusively in sub-Saharan Africa and South Asia, and accounts for 6% of all maternal deaths. Although already high, these numbers are also grossly underestimated and underreported, meaning that the burden created by this condition is much greater.
So, what exactly is an obstetric fistula? If this is the first time you are hearing the term, you are not alone, as fistula is a condition of poverty, and almost exclusively effects women and girls living in rural areas of low-income countries.
Fistula is a hole that forms between the genital tract and rectum or urinary tract resulting from pressure created on surrounding organs. This opening results in uncontrollable leakage of urine or feces and creates severe burn wounds on the legs and can even result in nerve damage. Fistula has two main causes; obstructed labor lasting for several days in which the baby presses against the organs, creating a hole, or in the case of traumatic fistula, the hole is formed as a result of sexual violence and rape, aggravated by the thrusting of objects into the vagina. Traumatic fistula is especially prevalent in areas of conflict, where it has been used as a weapon of war.
Not only can fistula result in the eventual loss of mobility and livelihood, due to the lack of medical understanding of the condition, it is often accompanied by equally debilitating social consequences. The constant leakage resulting from the condition produces a strong odor, which some communities have attributed to witch-craft, causing the affected women and girls to be marginalized and outcasted by their communities. These women are also often abandoned by their husbands and families, hurling them into complete isolation and left both socially and physically incapable of securing income and surviving on their own.
So why then, is this condition that is so unarguably prevalent and devastating often overlooked? Why do we have declarations on sexual and reproductive health rights if they are just going to be ignored? As obstetric fistula is recognized almost exclusively as a neglected problem of the poor, it often gets forgotten. And as the condition has been silenced by scientific literature, it is often left out of public health and humanitarian interventions.
Although this condition is accompanied by many upsetting realities, I would like to leave you with something good:
The first good thing is that fistula is completely preventable. As it is most often the result of early marriage and childbearing, malnutrition, and poor access to reproductive health care, addressing these factors can greatly reduce the incidence. The second good thing is that it is completely curable through surgery. Estimated to cost between US$100 and US$400 per procedure, although out of reach for most of the affected women, this cost is reasonable through aid. The final good thing that I would like to leave you with is the reminder that we have the simple but powerful tool of education, and through educating both ourselves and raising awareness in others, we can change the reality of these women and girls that are too often left silenced.