Gates Institute Hosts Meeting on Obstetric Fistula (web article)

Too often in the developing world, women who endure obstructed labor during childbirth suffer a double tragedy: they lose their babies, and then, in a way, they lose their own lives.  

This is the life-shattering reality of obstetric fistula, a condition estimated to afflict 2 million women in developing countries. Obstetric fistula occurs when sustained pressure of the baby’s head on the mother’s bladder or rectum during labor damages the tissue, creating a hole (fistula) that renders the mother incontinent. The problem often affects women and girls under the age of 15, before their pelvises are fully formed. As a result, the woman can no longer control the flow of urine, and sometimes feces, and sometimes both.  

Saifuddin Ahmed

It's not just a physical tragedy; it's a social one, too. The odor often drives husbands away, and many cultures regard the fistula as a curse from God. The woman becomes an outcast, condemned to a life of shame and isolation, humiliation and dire poverty. “They’re living but it’s almost like they’re dead,” said Saifuddin Ahmed, PhD, assistant professor of Population and Family Health Sciences. “The majority end up divorced or deserted and most beg for their livelihood.”

Ahmed was one of the organizers of a conference addressing obstetric fistula held July 28 and 29 at the Bloomberg School. Hosted by The Bill and Melinda Gates Institute for Population and Reproductive Health with the collaboration of the WHO, the United Nations Population Fund (UNFPA), and the International Federation of Gynecology and Obstetrics (FIGO), researchers, clinicians, program managers and donors  presented and discussed all manner of topics related to fistula ranging from prevention and clinical management of the disease, to various health system responses to the problem. Presenters included specialists from Ghana, Nigeria, and Niger and from Addis Ababa Fistula Hospital in Ethiopia. AA Fistula Hospital is a world-renowned hospital dedicated to caring for women with obstetric fistula and to training physicians from all over the world.

Even though the incidence of obstetric fistula may be as high as maternal mortality, the problem remains grossly underestimated, Ahmed says. The prevalence figure of 2 million is far too low, he says, but without good data, it is hard to attract attention to the problem.

And yet fistula can be prevented, and it can be cured. It can be prevented by delaying the first birth for girls, by defining high risk pregnancies and by providing emergency obstetric services. It can be cured with simple surgery. It’s a matter of people knowing about these services, and having access to them.  

K.A. Danso

K.A. Danso, BSc, MBBS, FWACS, a physician at the Komfo Anokye Teaching Hospital in Ghana who attended the conference, has seen first-hand how the surgery can change women’s lives. His hospital has no dedicated fistula center, but physicians do perform the surgery as part of the hospital's gynecological service. Since 1977, the hospital has performed nearly 300 fistula operations and trained many physicians for rural service. Danso has performed the majority of the surgeries since 1999.

He remembers one woman, a teacher, who suffered from the fistula for four years. The fistula cost her her job, and she separated from her husband.

“After she had the surgery and the catheter was removed 14 days later,” Danso remembers, “she said, ‘Thank God. Now I feel like a woman again.’ ” —Kristi Birch