What is obstetric fistula?

Obstetric fistula is an injury of childbearing that has been relatively neglected, despite the devastating impact it has on the lives of girls and women. It is usually caused by several days of obstructed labour, without timely medical intervention — typically a Caesarean section to relieve the pressure. The consequences of fistula are life shattering: The baby usually dies, and the woman is left with chronic incontinence. Because of her inability to control her flow of urine or faeces, she is often abandoned or neglected by her husband and family and ostracized by her community. Without treatment, her prospects for work and family life are greatly diminished, and she is often left to rely on charity.

How does fistula occur?

Unattended obstructed labour can last for up to six or seven days, although the foetus usually dies after two or three days. During the prolonged labour, the soft tissues of the pelvis are compressed between the descending baby's head and the mother's pelvic bone. The lack of blood flow causes tissue to die, creating a hole between the mother's vagina and bladder (known as a vesicovaginal fistula), or between the vagina and rectum (causing a rectovaginal fistula) or both. The result is a leaking of urine or faeces or both.

Why does it occur?

Fistula occurs when emergency obstetric care is not available to women who develop complications during childbirth. This is why women living in remote rural areas with little access to medical care are at risk. Before the medical advances of the 20th Century, fistula was quite common in Europe and the United States. Today, fistula is almost unheard of in high-income countries, or in countries where obstetric care is widely available.

Poverty, malnutrition, poor health services, early childbearing and gender discrimination are interlinked root causes of obstetric fistula. Poverty is the main social risk factor because it is associated with early marriage and malnutrition and because poverty reduces a woman's chances of getting timely obstetric care. Because of their low status in many communities, women often lack the power to choose when to start bearing children or where to give birth. Childbearing before the pelvis is fully developed, as well as malnutrition, small stature and general poor health, are contributing physiological factors to obstructed labour. Older women who have delivered many children are at risk as well.

What is the Campaign to End Fistula?

In 2003, UNFPA and its partners launched the first-ever global Campaign to End Fistula. Its overall goal is to make the condition as rare in the South as it is in the North. This includes interventions to:

  • Prevent fistula from occurring.
  • Treat women who are affected.
  • Renew the hopes and dreams of those who suffer from the condition. This includes bringing it to the attention of policy-makers and communities, thereby reducing the stigma associated with it, and helping women who have undergone treatment return to full and productive lives.

The Campaign currently covers more than 40 countries in sub-Saharan Africa, Asia and the Arab region.

In each country, the Campaign proceeds in three phases:

  • First, needs assessments are undertaken to determine the extent of the problem and the resources to treat fistula.
  • Second, each country that completes a needs assessment receives financial support for planning, including raising awareness of the issue, developing appropriate national strategies and building capacity.
  • Finally, a multi-year implementation phase begins, which includes interventions to prevent and treat fistula, such as improving obstetric care; training health providers; creating or expanding and equipping fistula treatment centres; and helping women reintegrate into their communities.


Related Links

»Healing Fistula, Restoring Hope in Nigeria
»Voices of Fistula Survivors