Report Raises Awareness of Obstetric Fistula

Special Issue of Obstetric Journal Brings Visibility to Devastating Postpartum Condition

Virtually eliminated in developed nations, a postpartum condition known as obstetric fistula continues to debilitate millions of women in developing nations, and in a special issue of the International Journal of Gynecology and Obstetrics, researchers at Johns Hopkins Bloomberg School of Public Health draw attention to the devastating effects of the condition, as well as to the need for more data and for an improved public health strategy. Obstetric fistula, a permanent condition resulting from obstructed labor and usually accompanied by fetal death, causes women to experience constant leakage of urine or feces. Unable to resume their functions as wives and mothers, these women often are ostracized by their families and communities. The supplement, funded by the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins School of Public Health and UNFPA (United Nations Population Fund), was released October 18 to coincide with the Women Deliver Global Conference in London.

Over the last century, fistula has become unknown in developed nations, as improvements in obstetric care, particularly in the availability of C-sections, have reduced the incidence almost to zero; in the rare cases of fistula in developed nations, treatment, which requires complicated surgery, is available.

In developing nations, however, when obstructed delivery (delivery lasting longer than three days) results in fistula, the woman not only suffers the loss of the child and the physical damage, but often she is stigmatized and shunned by her husband and community. “She becomes an outcast, and her life is changed forever—socially, economically, psychologically,” said Saifuddin Ahmed, PhD, one of the co-editors of the special issue and an assistant professor in the Bloomberg School’s Department of Population, Family and Reproductive Health.

“Until recently, this condition has been completely ignored by public health officials,” said Ahmed. In the special issue’s foreword, the co-authors contend that the continued existence of fistula is a “shameful affront” to those who plan and implement public health policies.

With funding from the UNFPA, Ahmed, René Genadry, MD, associate professor of obstetrics and gynecology in Johns Hopkins School of Medicine and Cynthia Stanton, PhD, MPH, an assistant professor at the School’s Department of Population, Family and Reproductive Health, will lead a study, expected to begin by the end of this year, in which they examine the social aspects of fistula—both the etiology of the condition and the patients’ re-integration into society after reparative surgery. A further goal of the study is to increase visibility of the condition and to develop a standardized classification system to improve its clinical management and repair. The seven countries included in the study are Bangladesh, Benin, Ethiopia, Mali, Niger, Nigeria and Sudan; Ahmed, Genadry and Stanton expect to work with the World Health Organization.

Because the surgery to repair fistula is complex, said Ahmed, “prevention is the key.” Amy Tsui, PhD, director of the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins School of Public Health, noted that C-sections are only part of the prevention. “In some countries,” said Tsui, “girls are having their first births at age 13, and their bodies just aren’t ready to deliver babies. Part of prevention is delaying the age of pregnancy, which means delaying the age of marriage.”
 
“Prevention and Treatment of Obstetric Fistula: Identifying Research Needs and Public Health Priorities,” was co-edited by Saifuddin Ahmed, PhD; René Genadry, MD, an obstetrician at Johns Hopkins School of Medicine; and Cynthia Stanton, PhD, MPH.

The supplement was funded by the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins School of Public Health and by UNFPA (United Nations Population Fund).