Washington, DC — An obscure health problem that affects only women was the topic of a panel at the Global Health Council's annual conference in Washington, DC this month. Obstetric fistula, panelists argued, is a crisis that modern public health systems have failed to address adequately. Maggie Bangser, a founder of the Women's Dignity Project, said that merely talking about the issue in an international forum is a sign of progress.
Obstetric fistula is a hole created between a woman's vagina and the bladder or the rectum or both, usually during childbirth. It is trauma that occurs as a result of a baby getting lodged in the mother's pelvis. The infant usually dies in the process, and if the mother survives, her pelvic tissue decays, creating the opening.
Fistulas most often occur in poor communities, where there is limited or no access to natal care.
"Fistula tells us where maternity health systems are failing," Mary Nell Wagner of EngenderHealth said. EngenderHealth is a non-governmental organization doing research, training and service delivery.
Panel speaker France Donnay, chief of reproductive health at the United Nations Population Fund (UNPF) said between 50,000-100,000 women suffer from obstetric fistulas each year. Most of those afflicted are African.
Fistulas are preventable and treatable, she said. The condition affects the "poorest of the poor" and often results from situations common in poverty stricken environments - childbearing at an early age, minimal access to emergency obstetric care and malnutrition, Donnay said.
The panel emphasized the multi-faceted nature of obstetric fistulas, stressing that the issue does not exclusively affect the individual's health. Donnay noted that there are numerous social consequences for women with fistulas, including: isolation, divorce, lack of opportunity and ostracism from the community.
To avoid this stigma, women often remain silent about their condition. Even in instances where women try to seek help, they often do not have access to health care, information, or other resources that would provide relief.
Dr. Oumarou Ganda, one of only ten trained gynecologists in Niger, provided the panel with a first-hand clinical account of obstetric fistula.
Fistulas are very common in a woman's first or second pregnancy, and the high instance of births at home exacerbates the occurrence of fistulas, he said.
Lack of education is a major reason women do not seek treatment. To illustrate the impact of negligible education, Ganda said most women do not even know that fistulas can be cured.
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Maimuna Kanyamala of the Kivulini Rights Organization is facing these obstacles directly in Tanzania. Innovative grassroots efforts can overcome challenges, she said.
While the Kivulini Rights Organization focuses mainly on domestic violence, it has incorporated the fistula issue into its agenda, because women and girls with fistulas are often targets of abuse. Kanyamala said fistulas and domestic violence are interrelated with a broader concern of gender inequality in African societies.
However, grassroots organizing, building partnerships with civil society, strengthening providers' skills and involving men in the process are all effective ways of addressing fistula, Kanyamala said. She urged the formation of groups to work with governments to translate policies and ideas into practice.
During the panel discussion, audience members watched a clip of "Love, Labor, Loss," a documentary due for release in September 2004, that deals with the issues associated with obstetric fistula.
