BY VIOLET KAKYOMYA
Tomorrow, May 23, is that special day set aside every year to remind all of us to take action to prevent obstetric fistula and support survivors.
Fistula is one of the most devastating injuries of childbirth. It occurs mainly as a result of prolonged obstructed labour, without timely medical intervention such as a caesarean section. The sustained pressure of the baby’s head on the mother’s pelvic bone causes damage of soft tissues creating a hole, or fistula, between the vagina and the bladder and/or rectum. The result is continuous leaking of urine and/or feaces. When this occurs, a woman has no control of this unnatural phenomenon and if not assisted may suffer isolation, social stigma, neglect and humiliation.
It is estimated that at least two million women live with the condition in Asia and sub-Saharan Africa, and 50 000 to 100 000 new cases occur every year globally. Studies in Malawi have revealed a prevalence of 1.6 per 1 000 women, and anecdotal evidence suggests that close to 20 000 women may be living with this condition.
Obstetric fistula leaves women with very limited opportunities to earn a living, and many have to rely on others to survive. In some cases, women are abandoned by the partners. Without treatment, the prospects for work and family life are severely diminished. Although some women with fistula display amazing courage and resilience, many others succumb to illness, despair and suicide. Obstetric fistula is preventable and treatable in the overwhelming majority of the cases.
To prevent obstetric fistula, it is necessary to ensure that all women of reproductive age have access to voluntary family planning services, so that every pregnancy is wanted and planned, and every birth is safe. It is critical to ensure that pregnant women have adequate access to focused antenatal care, skilled birth attendance and emergency obstetric care. It is necessary to address underlying social and economic inequities through initiatives aimed at empowering girls and women in our communities, to enable them to delay marriage and childbirth until the appropriate age.
For the cases that still occur, luckily, almost 90 percent of fistulas can be repaired successfully. Survivors often fully regain their reproductive health lives, and are able to work, earn livelihoods and fully reintegrate into their communities and families. Some of the women who have suffered obstetric fistula may not be aware of the availability of these services, or in some cases do not even have access to them. It is important to continuously strengthen national capacity for fistula management, while also vigorously tracing those already affected and linking them to the available services.
Beyond treatment, a woman who has experienced ostracism, isolation and discrimination at the hands of obstetric fistula often needs help to fully regain her life. This requires the support of the family and the community. Social reintegration programmes, including counselling are very helpful, including for the minority inoperable cases, who also have to be rehabilitated as much as possible.
Tomorrow, we renew our commitment to end fistula and join others in commending the tireless efforts the Government of Malawi, NGOs and communities for their contribution.
PREVENTION: Stakeholders, including community leaders and health workers are informing and sensitising communities to the causes and prevention of fistula as well as to orienting women to treatment facilities and family planning services. Programmes aimed at helping girls to stay in school are contributing to delay both marriage and pregnancy. Government and partners are working to improve the quality of emergency obstetric care and ensure adequate referral linkage for women who require assisted delivery and caesarean section for obstructed labour.
TREATMENT: Government, partners and stakeholders are working to improve capacity for the management of obstetric fistula. Health workers have been trained, and equipment and supplies for the management of obstetric fistula have been provided. Experienced obstetric fistula surgeons have been brought in from neighbouring countries to assist in repairs for more complicated cases, during fistula treatment camps and also train the local clinicians. Over 500 cases were repaired in 2014.
SOCIAL SUPPORT AND REINTEGRATION: Government, partners, communities and families are working hard to support social reintegration of survivors. This often includes support for education and training, and small-scale income-generation activities.
A lot remains to be done, especially given that we can only win if we emphasise prevention. We are slowly but surely restoring dignity and increasingly preventing this condition.
The future we want is one without obstetric fistula.