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The Politics of Women's Health

Obstetric Fistula

What is “fistula?”

Obstetric fistula is a childbirth injury that affects girls and women almost exclusively in resource-poor settings of Africa and South Asia. It results from an especially difficult childbirth and leaves women unable to control urine and feces. Vesico-vaginal fistula (“VVF”) is a hole that develops between the vagina and the bladder, and recto-vaginal fistula (“RVF”) is a hole that develops between the vagina and the rectum.

What causes fistula to occur?

Both VVF and RVF are the result of prolonged obstructed labor when a woman is unable to delivery her baby safely and cannot access a cesarean section. The constant pressure of the baby’s head against the mother’s pelvic bone causes the tissues to disintegrate between the vagina and the bladder and/or between the vagina and the rectum.

What are the effects of fistula?

The baby almost always dies as a result of the long labor, and the mother is left leaking urine and/or feces uncontrollably from the vagina. In addition, fistula can lead to ulceration of the genital area. It may also cause a condition known as “foot drop,” which makes it difficult or impossible for women to walk due to extreme nerve damage to the lower limbs.
Beyond these physical consequences, fistula often exacts a severe social toll, resulting in divorce or abandonment and varying degrees of social isolation. It is not uncommon for women with fistula to work alone, eat alone, and sleep alone.

Can fistula be cured?

Fistula can be cured. Fistula repair surgery, when carried out by a trained provider with the proper medical equipment and supplies, can yield success rates of over 90%. The biggest challenge faced by many women with fistula is reaching a health facility that has a surgeon trained in fistula repair. Countries with a high rate of fistula tend to have shortages of trained health care providers and health facilities overall and typically have only a few doctors (if any) trained in fistula repair.

What are the coping strategies of girls and women with fistula?

Despite the challenges of living with VVF/RVF, girls and women with fistula are typically strong and resourceful. They continue to support their families and themselves. They manage the significant responsibilities that poor women typically shoulder that include finding water, hauling firewood, cooking, caring for family members and working in the fields. They may spend years saving money to pay for medical care and transportation to a facility providing treatment.

What does fistula have to do with poverty and with gender and health equity?

Various socio-economic factors can increase a woman’s risk of fistula. The condition is mostly likely to affect those women who have very a low income (or have minimal control over their finances) and who lack access to preventive and emergency obstetric care. Women who cannot easily travel to hospital facilities, either because of long distances, high costs of transportation or lack of decision-making power in the family, are at an increased risk. Malnutrition and early childbearing are also associated with higher fistula incidence, because it is more difficult for a woman with a small pelvis to deliver her babies vaginally.

The root causes of fistula are deeply embedded in political, economic and social determinants that underlie poverty and vulnerability.  These include limited expenditure on priority social sectors that benefit the poor,  absence of governance structures that bring the voices of marginalized people into policy setting, lack of transparency in the use of public funds for basic services,  and the exclusion of women and girls from family and community decision-making.

How can fistula be prevented / avoided?

The best way for a woman to avoid fistula is to receive high-quality antenatal care, and to deliver at a health facility that has the necessary staff and equipment for deliveries. Beyond the health sector factors contributing to fistula, however, other social issues can make a woman more vulnerable to fistula. Programs that address poverty, gender inequity, education, and infrastructural barriers to reaching a health facility (such as roads and transportation systems) all have the potential to contribute to a reduced incidence of fistula over the long term.

How can I learn more about fistula?

For further information about fistula and its relationship to gender and health equity, please contact:

Women’s Dignity Project 
PO Box 79402  •  Dar es Salaam  •  Tanzania
Tel:  255.22.2152577 or 8  •  Fax:  255.22.2152986
Email: wdp@cats-net.com

Other Resources:

Written by: Maggie Bangser and Kristina Graff
Last revised: March 2005

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