"My husband threw me out because I was leaking."
"I know I will never have a husband, I will never have a boyfriend, I will never have a baby. So I just live by myself."
That’s how women in Asia and Africa describe their lives when they suffer from obstetric fistula, an injury of childbearing that has been vastly neglected by the public health community in developing countries. Fistula is usually caused by prolonged and obstructed labor unrelieved by Caesarian section. Its consequences are shattering: usually the baby dies and the mother is left with chronic incontinence which leads to unemployment and social isolation. Fistula can cause ulceration, infection, kidney disease and even death. While some women are driven to suicide, others have lived with the condition for forty years or more.
The World Health Organization estimates that more than two million women are living with fistula with an additional 50,000 to 100,000 new cases occurring annually. These figures are based on women seeking treatment; in fact, they may be grossly underestimated. With surgical intervention, the success rate for fistula repair is as high as 90 percent. But most women in the developing world cannot afford US$300 for surgery, even where facilities exist to provide it. So they suffer from this preventable and treatable curse.
In 2003, the United Nations Family Planning Agency (UNFPA) and several of its international partners launched the first-ever global Campaign to End Fistula with the overall goal of making the condition as rare in the South as it is in the North. A set of interventions have been developed aimed at prevention, treatment, and stigma reduction. Currently, more than 35 countries are participating in the Campaign which proceeds in three phases: First, a needs assessment is undertaken to determine the extent of the problem and the resources available to treat fistula. Second, each country that completes a needs assessment receives financial support for planning and raising awareness of the issue so that national strategies can be developed. Finally, a multi-year implementation phase begins which includes interventions for prevention and treatment. These interventions can include improving obstetric care and training health providers as well as helping women reintegrate into their communities.
So far more than US$ 14 million has been mobilized from various donors to combat the problem of obstetric fistula. In Bangladesh, for example, where some 70,000 women are living with fistula, a Fistula Repair Centre has been established at the Dhaka Medical College. In Benin, a curriculum of study on reproductive health, including fistula, has been incorporated into the major health university and other public health schools. Fistula treatment centers have been established in Chad and media broadcasts there are helping to change public perceptions of fistula. Sudan’s national campaign to raise awareness, "We MUST Care," is augmented by eight volunteer doctors who manage the Fistula Centre in Khartoum. And in Zambia, the Campaign is supporting the fistula repair unit at Monze Mission Hospital, where initial efforts have resulted in increased referrals and improved quality of care.
Glenn Strauss is a physician who helps by volunteering for Mercy Ships, a global faith-based organization that specializes in delivery of services to the forgotten poor of the world. The ship he and an international voluntary staff work on delivers quality medical care and a caring, healing environment for patients of all races and religions. Mercy Ships has partnered with UNFPA to provide training for surgeons who can then offer surgical interventions to women with fistulas. "The world should know that fistula is a condition resulting from lack of basic maternal services. This condition takes the woman’s dignity and life from her, often leaving her an outcast. It is truly an honor to volunteer my services to meet the needs of those who have no hope," Strauss says. "If my skills can be used to restore hope and health in the lives of forgotten people, I have made the best investment of my time."
Obstetric fistula is a key issue in reproductive and adolescent health and in gender equality and women’s empowerment. Because of the many factors that contribute directly and indirectly to fistula, addressing the problem can serve as an entry point for other improvements in women’s reproductive health and human rights. As Mary Nell Wagner of EngenderHealth puts it, "Fistula tells us where health systems are failing."
Fistula is a hidden problem because it affects the most marginalized members of society: young, poor, illiterate women in remote areas. These women suffer alone. The Campaign to End Fistula is working to break the silence surrounding this condition and the stigma attached to it.
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Elayne Clift writes about women, health and development from Saxtons River, Vt. Her latest edited collection is Women, Philanthropy and Social Change: Visions for a Just Society (UPNE/Tufts U. Press, 2005).