What is obstetric fistula? A fistula is a hole or opening made between two internal organs. An obstetric fistula is the result of a prolonged obstructed labor in which the fetus’ head is pushed against the pelvic bone. The head effectively cuts off blood flow to the soft tissue of the pelvis, causing necrosis (tissue death). The body eventually expels the dead tissue, leaving a hole between the bladder and vagina or rectum and vagina.

Are there different types of fistulas? Obstetric fistulas develop in two serious forms. The most common vesico-vaginal fistula (VVF) occurs after a prolonged labor and leaves a hole between the bladder and the vagina, creating urinary incontinence. The more complicated and severe recto-vaginal fistula (RVF) occurs when a fistula develops between the vagina and rectum, creating fecal incontinence.

Is there a treatment for obstetric fistula? Yes. A fistula can be corrected through surgery. Ethical fistula repair by a skilled surgeon has a high success rate of more than 90%.

How pervasive is OF? Although data on obstetric fistula is scarce, most estimates find that at least 2 million women in the developing world currently suffer from this condition. Moreover, at least 100,000 additional women develop fistulas every year. Most cases occur in the developing world, specifically in sub-Saharan Africa and South Asia. These societies tend to have undeveloped or underdeveloped emergency obstetric services.

How much does a surgery cost? The cost of a corrective surgery ranges between $250 and $450, depending on the complexity of the fistula.

Who is most susceptible to develop a fistula? Poor, uneducated women and girls who have no access to prenatal maternal healthcare are most susceptible to obstetric fistula. Many young girls who marry at an early age are more likely to suffer from an obstetric fistula. These girls have smaller pelvises that have not fully developed and often cause obstructed birth.

How do poverty, inequality and education relate to obstetric fistula in the developing world? Fistulas are most prevalent in the poorest areas on Earth where women rarely have access to medical treatment during pregnancy. In some countries a woman’s status is so low, her husband may prevent her from seeing a proper gynecologist or doctor. He may not approve of other people seeing her body despite the horrific repercussions of such restrictions. Women who develop fistulas often see themselves as cursed. They suffer quietly on the margins of their villages; cast out by their own communities. They are unaware that a surgery is available to correct this condition and are likely unable to pay the transport costs or surgery fees at the few hospitals that offer operations.

Can obstetric fistula be prevented? Through adequate access to prenatal and postnatal maternal healthcare, obstetric fistula can be prevented. Emergency cesarean surgery during labor can avert prolonged obstructed labors.

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