International Day To End Obstetric Fistula


Obstetric fistula is a child birth injury resulting largely from prolonged obstructed labour in a setting where access to emergency obstetric care is limited. Consequently a hole develops between the birth canal and the bladder or between the birth canal and the rectum or both.The patient becomes incontinent of urine or faeces or both. Due to the constant odour of urine and faeces, they are treated at arm’s length and suffer immense social abandonment, stigmatization and ostracism. This situation is further worsened by cultural beliefs regarding the cause of obstructed labour and fistula.

The first hospital for treating obstetric fistula was set up in New York City in May 1855. Forty years later, the hospital was closed down when it was eradicated. In its place today stands the Waldorf Astoria Hotel. In 1974, the world’s second hospital dedicated to obstetric fistula was started in Ethiopia. Forty-three years down the line, fistula is far from being eradicated in Ethiopia and indeed in Sub-Sahara Africa and Asia. Despite repairing nearly 30 thousand women over the last 30 years, Nigeria still has the highest burden of obstetric fistula in the world.

What is Sub-Saharan Africa missing in the narrative to end obstetric fistula?

In Ghana, the programmatic battle against fistula coincided with the UNFPA global campaign to end obstetric fistula launched in 2005. Ten years after the launch, a report on the burden of obstetric fistula in Ghana was produced. In the burden report 1,300 new cases of obstetric fistula develop each year. Out of this figure, about 200 fistula repairs are carried out each year. The obvious question is, where are the remaining 1,100 fistula cases?

To give meaning to Ghana’s campaign to end obstetric fistula, it is incumbent on all to help identify women living with obstetric fistula especially in the rural areas. Once identified, every effort should be made to get these women and girls to the hospitals for cure.

The culture of blaming the patients for their predicament should be stopped. The regional houses of chiefs have a role to play in refining the cultural interpretations given to obstructed labour. Mass education on obstetric fistula is key. Leprosy, Tuberculosis and HIV were stigmatized in the past. With education, many came out to be treated. Leprosy has been eliminated. Tuberculosis and HIV are under control. De-stigmatizing obstetric fistula will encourage more women suffering from the disease to come out for treatment.

The District Assemblies should join the campaign as was done for Guinea worm eradication, incentive packages can be considered for finding and reporting obstetric fistula cases. If developed countries have eliminated obstetric fistula, there is hope that this can be achieved if we identify the missing links in our elimination narrative. As we join the world to bring hope, healing and dignity to all women suffering from obstetric fistula, let us also put our shoulders to the wheel to find and bring those suffering from obstetric fistula for treatment. That should be the clarion anytime we join the global community to observe the international day to end obstetric fistula.

BY: DR.GABRIEL GANYAGLO. OBSTETRICIAN GYNAECOLOGIST, KORLE-BU TEACHING HOSPITAL.

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