Obstetric fistula | United Nations Population Fund – UNFPA

Obstetric fistula is one of the most serious and tragic childbirth injuries. A hole between the birth canal and bladder and/or rectum, it is caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It leaves women and girls leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. Half a million women and girls in sub-Saharan Africa, Asia, the Arab States region and Latin America and the Caribbean are estimated to be living with fistula, with new cases developing every year. Yet fistula is almost entirely preventable. Its persistence is a reminder of gross inequities, a sign of global inequality and an indication that health and social systems are failing to protect the health and human rights of the poorest and most vulnerable women and girls. As the leader of the global Campaign to End Fistula, UNFPA provides strategic vision, technical guidance and support, medical supplies, training and capacity building, as well as funds for fistula prevention, treatment and social reintegration and advocacy programmes. UNFPA also strengthens sexual and reproductive health care including timely and quality emergency obstetric services to prevent obstetric fistula from occurring in the first place.

How it happens

Without emergency intervention, obstructed labour can last for days, resulting in death or severe disability. The obstruction can cut off blood supply to tissues in the woman’s pelvis. When the dead tissue falls away, she is left with a hole – a fistula, in medical terms – in the birth canal.

Tragically, there is a strong association between fistula and stillbirth, with research indicating that approximately 90 per cent of women who develop obstetric fistula end up delivering a stillborn baby.

Obstetric fistula has been virtually eliminated in industrialized countries through the availability of timely, high-quality medical treatment for prolonged and obstructed labour – namely, Caesarean section. Obstetric fistula occurs mostly among the poorest and most marginalized women and girls, especially those living far from medical services and those for whom services are not accessible, affordable or acceptable. Childbearing in adolescent girls before the pelvis is fully developed, as well as twin pregnancy, breech position of the baby, malnutrition, small stature and generally poor health conditions are among the physiological factors contributing to obstructed labour. However, any woman may experience obstructed labour, including older women who have already had babies.

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What We Do – Operation Fistula

. SUPPORT SURGEONS, COMMUNITIES AND HEALTH SYSTEMS TO BETTER SERVE PATIENTS

We provide performance-based funding to surgeons who treat obstetric fistula in the world’s poorest places

Patients have no resources to pay for care. Doctors cannot access funding to provide free care.

Operation Fistula gives unrestricted funding directly to surgeons after they’ve done the work. Unlike traditional funding models that give money upfront and control spending, our program trusts the people closest to the problem to allocate these resources to best meet the needs of their patients and local context.

Our funding flows directly to surgeons when they provide data to validate that high-quality care has been provided at zero cost to the patient. Our innovative funding increases the availability of a proven treatment to vulnerable women, improves quality of care, and shows how systems are failing women and girls more broadly.

We currently fund treatment in 22 countries.

We spread the message that fistula is a treatable injury, and not a curse.

Many women have no idea that their suffering is caused by a treatable injury.

We use satellite images to map regions and identify vulnerable populations where fistula is likely prevalent. We engage local people with radio and social media to raise awareness within these remote populations. We operate a national hotline so that patients can call in from anywhere and seek help. We send people into remote villages to meet with local leaders and communities and share that women with fistula can access free treatment.

We currently deliver outreach to communities in Madagascar and are replicating our approach in Senegal in partnership with Tostan.

We break down barriers that keep women from seeking care

Some women remain unable or unwilling to seek care, even when they know free care is available.

We listen to patients and work to eliminate the barriers to care that they experience. We bring diagnostics closer to patients to avoid unnecessary medical transfers. We create Hope Centers near surgical centers that are staffed with social workers to support, counsel, and prepare patients for treatment and care. We operate a national referral network that can quickly send patients to the right surgeon and facility. We book, manage, and pay for the roundtrip travel logistics for the patient. We do all of this to enable, encourage, and empower women to seek care.

We are currently eliminating barriers to care in Madagascar and are replicating our approach in partnership with Tostan in Senegal.

We aim to dramatically improve every patient’s quality of life

The absence of a bad thing does not mean the presence of a good thing.

We know that fistula surgery can fix the acute medical problem, but it cannot cure the chronic psychological, social, or economic problems that fistula leaves in its wake. We must understand the breadth and depth of these problems in order to develop solutions. That understanding comes by listening directly to patients.

That’s why we launched the development of a Quality of Life Tool. We interviewed patients to understand the various dimensions of quality of life and are developing a tool to measure it. This tool will enable us (and other fistula treatment organizations) to quantify each patient’s quality of life before, during, and after their care. It will also empower the fistula sector to collectively deliver more customized interventions to meet those patient needs over time.

We are currently developing and testing the Quality of Life Tool in Madagascar with plans to share it globally, once it is validated