–Kim Fleming
Telanish Shabera’s story is an all too common one. She was married at age 10 and pregnant with her first child by the time she was 12. Her labor lasted for 3 days before she was transferred to a hospital, where she delivered a stillborn baby; but that was just the beginning of her troubles. The obstructed labor caused her to develop an obstetric fistula, leaving her incontinent. Her incontinence causes her to constantly leak urine, further creating hygiene, health and social problems for Telanish. She worries about the smell caused by her incontinence and carries the burden of shame. At the age of 14 Telanish is one of somewhere between 50,000-100,000 new women affected by obstetric fistula each year, most of whom live in impoverished parts of Africa and Asia. The WHO has incomplete statistics as the numbers are notoriously hard to track given the affected populations, but the best estimate is that some two million women in underdeveloped nations are suffering from the effects and complications of obstetric fistula.
A fistula is a hole in normal tissues where it doesn’t belong; obstetric fistulas occur between the vaginal wall and the organs normally separated from the vagina. Obstetric fistulas are caused by prolonged, obstructed labors in which the persistent pressure of the emerging baby’s skull against its mother’s delicate pelvic tissues cuts off blood flow to the area. After an extended length of time, the affected tissue dies, eventually opening up a hole between the vagina and the bladder, the vagina and the rectum or in the worst cases, both. When such holes develop, the affected woman is rendered essentially infertile, will find it virtually impossible to remain continent and she will leak urine and/or feces uncontrollably. All data available indicate that most women who suffer from untreated obstetric fistula are ostracized because of their infertility and the smell caused by poor hygienic conditions and incontinence.
Few women who experience obstetric fistula have the means to easily access medical care, though the surgery to repair the problem is a relatively simple one. Nonetheless, options are growing; the Fistula Foundation, Doctors Without Borders and the Operation to End Fistula are all funding organizations aimed at treating fistula and helping women to get their lives back to normal. The Addis Adaba Fistual Hospital was founded in 1974 in Ethiopa and has treated more than 30,000 women suffering from obstetric fistula. In recent years the hospital has opened up clinics in more rural regions of Ethiopia aimed at providing access to women for whom Addis Adaba is too far or too expensive to reach. Similar operations have been opened in the Congo, Angola, Afghanistan and India and focus on not simply repairing the fistulas once they’ve developed.
Extreme poverty, low status of women and girls and cultural paradigms that encourage the marriage of very young women and girls are the essential causes of obstetric fistula. Poor nutrition in children exacerbates the problem, creating women for whom skeletal (and thus pelvic) growth was stunted, which can itself lead to obstructed labor and obstetric fistula in much the same manner as a pregnancy in a girl too young to successfully deliver. Therefore, education and prevention programs can be an important part of dealing with this problem. The United Nations Population Fund (UNFPA) with its Millennium Development Goals is making strides in this area as they work to promote gender equality. A cornerstone of this goal is encouragement of equal enrollment by boys and girls in school, which has the secondary effect of delaying early marriage and too-early pregnancy.
The existence of obstetric fistula as such a wide-spread and under-treated problem becomes all the more tragic when one considers that it is an issue virtually obliterated in developed nations, occurring most often as the result of operative damage where access to easy and successful repair is immediate. Like many issues that affect only the poorest and most marginalized of women in the world, obstetric fistula is far too easy to ignore. Though we feel far removed and safe from such problems, we cannot let them go unsolved. Don’t let another woman like Fauzia from Kabul lose a child in stillbirth at the age of 10, and then suffer for 25 years with the debilitating and stigmatizing conditions brought on by her associated fistula. Learn more, stay involved, teach others and make donations. Your concern could have saved the girl Fauzia from pregnancy so young, and it could have prevented the woman Fauzia 25 years of poor health and stigma.
Stay informed on this issue, and how you can help make a difference by following the news releases of the primary organizations involved in combatting the causes of, and providing cures for, obstetric fistula. Sign up to receive a newsletter, make a donation or even volunteer to become a Circle of Friends Ambassador (http://www.fistulafoundation.org/whatyoucando/circleoffriends/) Donations can be made and more information can be found at the following sites.
http://www.endfistula.org/q_a.htm
http://www.fistulafoundation.org
http://www.doctorswithoutborders.org/publications/alert/article.cfm?id=3196