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what is fistula?
fast facts & FAQs
fistula links
one woman's story
doctor's corner
Obstetric fistula is the most devastating of all pregnancy-related disabilities.
~UNFPA
Obstetric fistula is the most dramatic aftermath of neglected childbirth.
~WHO
Vesico-vaginal fistula is a debilitating, humiliating, and life-threatening result of obstructed labor.
~AMDD
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Fast Facts
- Fistula used to be present in the U.S. and Europe,
but was largely eliminated in the latter part of the
19th century and early 20th century with improved obstetric
care in general and the use of c-sections in particular
to relieve obstructed labor.
- The World Health Organization estimates that approximately
2 million women have untreated fistula and that approximately
100,000 women develop fistula each year. Fistula
is most prevalent in sub-Saharan Africa and Asia.
- There are an estimated 100,000
women suffering with untreated fistula, and another 9,000
women who develop fistula each year.
- Less than 6 in 10 women in developing countries give
birth with any trained professional, such as a midwife
or a doctor. When complications arise,
as they do in approximately 15% of all births, there
is no one available to treat the woman, leading to disabling
injuries like fistula, and even death.
- The root causes of fistula are grinding poverty and
the low status of women and girls. In developing
countries, the poverty and malnutrition in children contributes
to the condition of stunting, where the girl skeleton,
and therefore pelvis as well, do not fully mature. This
stunted condition can contribute to obstructed labor,
and therefore fistula.
- But, fistula is both preventable and treatable. For
instance, the Addis Ababa Fistula Hospital has treated
over 30,000 women over 33 years. Their cure
rate is over 90%. Fistula can be prevented
if laboring women are provided with adequate emergency
obstetric care when complications arise.
Frequently Asked Questions (FAQs)
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| Q: |
What is a
fistula? |
| A: |
A fistula is a hole. An
obstetric fistula of the kind that occurs in many
developing countries is a hole between a
woman's birth passage and one or more of her internal
organs. This hole develops over many days of obstructed
labor, when the pressure of the baby's head against
the mother's pelvis cuts off blood supply to delicate
tissues in the region. The dead tissue falls away
and the woman is left with a hole between her vagina
and her bladder (called a vesicovaginal fistula
or VVF) and sometimes between her vagina and rectum
(rectovaginal fistula, RVF). This hole results
in permanent incontinence of urine and/or feces.
A majority of women who develop fistulas are abandoned
by their husbands and ostracized by their communities
because of their inability to have children and
their foul smell. Traumatic fistula is the result of
sexual violence. The injury can occur through
rape or women being butchered from the inside with
bayonets, wood or even rifles. The aim is
to destroy the women and the community within which
the sufferer lives. Once committed the survivor,
her husband, children and extended family become
traumatized and humiliated. The Panzi
Hospital in Congo is a pioneer in treating victims
of traumatic fistula. |
| Q: |
Can fistula be "cured"? |
| A: |
Yes. An obstetric fistula can
be closed with intravaginal surgery. If her surgery
is performed by a skilled surgeon, a fistula patient
has a good chance of returning to a normal life
with full control of her bodily functions. |
| Q: |
How much does it cost to treat obstetric
fistula? |
| A: |
For example, at the Hamlin Fistula Hospitals, it
costs US$450 to provide one woman with a fistula
repair operation, high-quality postoperative care,
a new dress, and bus fare home. |
| Q: |
What are the causes of
obstetric fistula? |
| A: |
A fistula results from an obstructed
labor that is left unrelieved and untreated. It
is estimated that 5% of all pregnant women worldwide
will experience obstructed labor. In the United
States and other affluent countries, emergency obstetric
care is readily available. In many developing countries
where there are few hospitals, few doctors, and
poor transportation systems, and where women are
not highly valued, obstructed labor often results
in death of the mother. When she survives, there
is a great likelihood her child will die and she
will develop a fistula. According to the United
Nations Population Fund (UNFPA), there are three
delays that contribute to the development of a fistula:
delay in seeking medical attention; delay in reaching
a medical facility; and delay in receiving medical
care once arriving at a health care facility. |
| Q: |
I heard that fistulas
are a result of female genital mutilation. Is this true? |
| A: |
While harmful traditional practices
such as female genital mutilation (FGM) are rightly
of concern to the international medical community,
they are not major contributors to the development
of an obstetric fistula. Some patients have been
victims of FGM, but their fistulas are almost always
caused by an obstructed labor resulting from a
too-small pelvis or a malpresentation of the baby.
FGM does not "cause" a fistula.
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| Q: |
How many women does this problem affect? |
| A: |
Because fistula affects women
in the most remote regions of the world, an accurate
count is very hard to achieve. The most common
estimate is that 100,000 women worldwide develop
fistulas every year, though some estimates put
the number closer to 500,000. Because most fistula
sufferers are young women—many still in their teens—they are likely
to live with their condition for upwards of 25 years.
By any estimate, there are at least two million
women currently living with fistula throughout the
developing world. The world capacity to treat fistula
is estimated at 6,500 fistula repair surgeries per
year. |
| Q: |
Where is fistula prevalent? |
| A: |
There is a high incidence of fistula
in Africa and parts of Asia, but women are susceptible
to developing fistulas wherever there are insufficient
emergency obstetric care systems. |
| Q: |
Can obstetric fistula be prevented? |
| A: |
Any woman who can gain access
to emergency obstetric care such as a cesarean
section will not develop a fistula. |
| Q: |
What can I do to help? |
| A: |
A tax-deductible donation
to the Fistula Foundation directly assists in restoring
health and dignity to women suffering from
fistulas.
The Fistula Foundation is also expanding its Circle
of Friends, a program which assists groups
and individuals who want to hold their own fundraisers
to support the Foundation's work to help women
with fistulas in developing countries. If you
have questions about any of our programs, feel
free to email us at info@fistulafoundation.org. |
For answers to frequently asked questions about making a charitable contribution to help fight fistula, visit our FAQ About Giving page.
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