What is an Obstetric Fistula and How Can it be Prevented?

An abnormal opening between the vagina, bladder and/or rectum that results from labor is known as a fistula, most frequently due to obstetric labor. Between 50-100k women annually are affected by an obstetric fistula while more than 2 million young women living in Asia and sub-Saharan Africa live with untreated fistulas that cannot be surgically repaired; fistula repair surgery was once common practice in Western countries during late 1800s but eventually closed just before 1900 due to limited funding from healthcare authorities.

Obstetric fistulas can have devastating health repercussions for women. Unable to regulate constant urine leakage, there may be foul-smelling vaginal discharge or stool passage as well as possible chronic infections and pain recurring regularly – driving away friends and family and leaving her vulnerable in society.

Obstetric fistula as an entity isn’t directly addressed in the SDGs; however, its improvement falls under SDG3 which promotes maternal health:

• Indicator 3.1.1: The Maternal Mortality Ratio measures the percentage of women who per 100,000 live births die due to pregnancy-related causes during gestation or within 42 days post-pregnancy termination.
• Indicator 3.1.2: Percentage of births attended by personnel trained to provide supervision, care and advice during gestation, labor and postpartum; to facilitate deliveries without medical intervention and care for newborns.

Fistulae can occur for various reasons unrelated to labor, namely iatrogenic and traumatic fistulae. Iatrogenic fistula can happen when the bladder is accidentally cut during cesarean section or surgery unrelated to childbirth; radiation of pelvic area radiation therapy or rare cases radiation therapy itself could result in fistula formation as can sexual violence by cutting the vagina or pushing objects in.

Obstetric fistula can be prevented with various measures, including:

Delaying first pregnancy; ceasing harmful traditional practices; and providing timely access to obstetric care services are among the steps needed for effective reproductive healthcare services in developing nations.