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What is the campaign to end fistula?

Jan 26, 2010, 2:28 PM

In 2003, UNFPA and it 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 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 interventions to prevent and treat fistula, such as improving obstetric care; training health providers; creating expanding and equipping fistula treatment centres; and helping reintegrate into their communities.

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 to 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 pelvis 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 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 the little access to medical care are at risk.  Before the medical advances of the 20th Century, fistula was the 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 may 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.

Are there other kinds of fistula?

Fistulas, or holes in organs, can occur for various reasons in different part of the body, such as the lungs or digestive tract.  Tissue damage resulting from prolonged obstetric labor and resulting in incontinence is called "obstetric fistula."  Tissue damage between the bladder and vagina is called vesicovaginal fistula.  Rectovaginal fistula, which is less common, refers to damage between the rectum and vagina.  Often it the rectum sustains a fistula, the bladder will also have been damaged and a woman will leak both urine and faeces.

The vaginal canal can also be ruptured by violent rape.   In 2003, thousands of women in esteem Congo presented themselves for treatment of traumatic fistula caused by systematic, violent gang rape that occurred during the country's five years of war.  So many cases have been reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime or combat.

How widespread is it?

Fistula is most common in poor communities in Sub-Saharan Africa and Asia where access to or use of obstetric care is limited.  An estimated two million women remain untreated countries and at least 50,000 to 100,000 new cases occur each year. But good data on fistula prevalence is scarce.  Needs assessments conducted as part of the Campaign to End suggest these estimates are far too low.

Why do so few people know about fistula?

Fistula is a relatively hidden problem, largely because it affects the most marginalized members of society: young poor, illiterate women in remote areas.  Many never present themselves for treatment. Because they often suffer alone, their terrible injuries may be ignored or misunderstood.  The campaign to End Fistula is working to break the silence around this condition and the stigma attached to it.

How can fistula be prevented?