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What is obstetric fistula?

Obstetric fistula is a childbirth injury that destroys a woman’s life. It leaves her incontinent, humiliated and too often shunned by her community. Surgery is the only cure.

How Fistula Occurs

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but doesn’t have access to emergency medical care, such as a C-section. She often labors in excruciating pain for days. Tragically, her baby usually dies.

During her prolonged labor, the mother’s contractions continually push the baby’s head against her pelvis. Soft tissues caught between the baby’s head and her pelvic bone become compressed, restricting the normal flow of blood.

Without adequate blood supply, sections of tissue soon die, leaving holes—known as “fistulae” —between the mother’s vagina and her bladder or rectum. It is these holes that cause incontinence. If untreated, the woman will uncontrollably leak urine, stool, or sometimes both, for the rest of her life.

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Today, at least one million women in Africa and Asia needlessly suffer from untreated fistula.

How Fistula Impacts a Woman’s Life 

Obstetric fistula most commonly occurs in poor, rural areas of Africa and Asia where the women affected live in dirt-floor dwellings and lack access to running water and incontinence pads.

Under these circumstances, a woman with fistula faces devastating physical and psychological consequences. Unable to control the leaking of her body’s waste, she suffers with chronic infections and pain. Too often, her smell drives away her husband, family and friends. 

With little community understanding of fistula and its causes, a woman is frequently blamed for her condition. She too often lives in isolation, unaware that others share her injury and that it is treatable. Because fistula usually occurs during a woman’s first pregnancy—when she is in her teens or early twenties—she will likely suffer for decades, if it is not repaired.

Can obstetric fistula be cured?

Yes. An obstetric fistula can be closed with corrective surgery. If the operation is performed by a skilled surgeon, a woman with fistula  can very often return to a normal life, with her continence and hope restored.

Fistula most commonly occurs to women in their early twenties, in countries where the average life span is approximately 65 yearsmeaning a one-time surgical intervention can restore 40+ years of health.

Does obstetric fistula occur in wealthy countries?

Even though obstructed labor occurs in approximately 5% of all child births worldwide, obstetric fistula has largely been eradicated in wealthy countries, thanks to the advent of the Cesarean section in the early 1900s. 

Today, fistula persists in low-income countries where women have limited access to emergency obstetric care. It continues to destroy women’s lives at an alarming rate in poor, rural regions of Africa and Asia, where  fewer than 6 out of 10 women give birth with a medical professional present.

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What are the root causes of obstetric fistula?

Fistula is a symptom of deep, intractable poverty and the low status of women and girls.

In poor countries, many children are malnourished, which can stunt their growth. If a young mother’s pelvis is not fully mature, she is at an increased risk of experiencing an obstructed labor—and with it, devastating childbirth injuries like obstetric fistula. 

The practice of early marriage and young pregnancy, when a girl’s body is not fully grown, also increases her risk of fistula. 

Another key cause of fistula is a critical lack of doctors and medical facilities. Over half of the countries in sub-Saharan Africa do not meet the minimum WHO ‘Health for All’ standard for an acceptable doctor to population ratio, which is set at one doctor per 5,000 individuals. By comparison, the US has 12 doctors per 5,000 people.

Why Are Women Still Suffering?

Women in Africa and Asia are needlessly suffering today for want of a single surgery that can completely transform their lives.

Fistula repair surgery was a common practice in wealthy, western nations in the late 1800s.

Fistula Foundation exists to remove all barriers to treatment, so that every woman can have access to high-quality fistula care.

Learn about barriers to treatment

Taking action means saying 'no' to indifference...It is a choice: whether or not to support a woman, whether or not to protect her, whether or not to defend her rights.
Dr. Denis Mukwege 2018 Nobel Peace Prize winner and fistula surgeon

Fistula Foundation works to end the suffering caused by obstetric fistula, because we believe no woman should endure a life of misery simply for trying to bring a child into the world. 

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