PPD will pay tribute on 23 May 2017, the International Day to End Obstetric Fistula, with the international community on the theme “hope, healing, and dignity for all’.
At the 2012 General Assembly, Resolution A/RES/67/147 clearly reaffirmed that from 2013 there would certainly be a renewal and reinforcement of the commitment made by Member States towards achieving Millennium Development Goal 5.
Recent studies by various organizations identify that worldwide there is a drop in lifetime risk of maternal deaths by more than half, from 14 maternal deaths per 1000 women over their lifetimes
(80% UI 13–15) in 1990, to 6 (5–6) maternal deaths in 2015. This then reads as 1 death per
73 women (66–78) in 1990, and 1 death per 180 women (160–190) in 2015. Occurrence in eastern Asia (84%) and southern Asia (81%) have demonstrated the highest decline with the largest absolute decline being in sub-Saharan Africa, where the risk decreased from 1 per 16 women (80% UI 14–18) in 1990, to 1 per 36 women (30–39) in 2015. It is mainly in the developing countries that such deaths occur.
Meanwhile, statistics in 2015 state that Obstetric Fistula is alarmingly widespread amidst about 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean. The existence of fistula being the barometer of maternal health in the country, the injury of Obstetric Fistula is sometimes identified as the proxy indicator of maternal health. Also any decline in fistula rated annually is a sign of improving maternal health.
What is even more distressing is that some 50,000 to 100,000 new cases are reported to be developing each year. On a brighter note, fistula is almost entirely preventable and curable. The flip side to this however is that about 70% of women living with fistula never had this problem addressed because they are in ignorance of this fistula problem. But what comes in their way and poses as a major challenge is the question of mobility to the surgical centers. Transportation poses to be physically difficult and financially burdening. If timely addressed, this vaginal surgery could yield a success rate of over 90% when carried out by a trained provider with proper medical equipment.
Barriers to Obstetric Fistula Treatment in Low-Income Countries: A systematic Review, 2014 by Population Council reports an aggregate prevalence of 0.29 cases per 1,000 women of reproductive age and incidence of 0.09 new cases per 1,000 recently pregnant women each year, suggesting no more than one million women worldwide currently living with fistula. However, because many of the women who are deeply affected by Obstetric Fistula are unable to access care, the estimate of injury is always severely underestimated. The fistula problem has its major identified determinants in early marriage, early or repeated childbearing along with poverty and lack of access to quality healthcare in pregnancy and at birth. Hence this problem is certainly very scary.
Skilled care before and after birth, particularly during labour, can be the determining factor to prevent Obstetric Fistula. But the harsh reality is that only half of the women in developing countries receive assistance from a skilled attendant during delivery.
Apart from the affected mothers being ignorant, many a time it is the inadequacy and ignorance of the medical personnel that also comes in the way of timely referrals. A discussion on fistula is never a part of a health visit. Most developing countries have a limited number of health personnel and hence they are able to provide new mothers only with most basic information. Promoting professional ethics and professional skills are a major part of the solution of the stated injury of obstetric fistula. What is obvious hence is that even with the best of intentions; some efforts can create challenges for not only health care providers but also make patients who live under adverse conditions exceptionally vulnerable.
Ending Obstetric Fistula would be arrived at only if the focus of developing countries would be on three integrated components – Prevention, Treatment and Rehabilitation.
Obstetric fistula is preventable by largely avoiding by
- Delay in the age of the woman’s first pregnancy;
- End of harmful traditional practices;
- Timely access to obstetric care.
The presence of Obstetric Fistulas in any country projects the quality and effectiveness of its health care delivery system. Until 2012, with more than 30 partner countries of the UNFPA countries having integrated fistula into their relevant national policies and plans, above 27,000 women have received fistula treatment and care under the Campaign to End Fistula. But still the work ahead is enormous. There is absolute need for a thorough understanding of this severely neglected health and human rights tragedy within the social context in which obstetric emergencies arise and how they are addressed in developing countries. Collective action can eliminate fistula, ensuring that girls and women who suffer this devastating condition are treated in time for them to be able to live in dignity.
There is gap found in the PPD member countries regarding the data availability on the prevalence rate of fistula and the urgency is to address this with the highest priority. On the occasion of the International Day to End Obstetric Fistula, PPD Secretariat would like to call upon all the Member Countries to increase investments and programmatic implementation to end fistula and rehabilitate the affected women and enable them to continue living with dignity.
The Global South carries the immense burden of Obstetric Fistula. This has to see an end. It is for Member Countries to consistently and consciously work with a firm political commitment towards elimination of child marriage and also improve on adequate institutional care for the pregnant women.
In an unequal world, those women living with fistula are the most unequal among unequal. A world free of the burden of fistula can offer a dignified life for the poorest of the poor women of the developing countries. PPD would like reiterate in concurrence that ‘dignity for all’ is one of the agreed goals of sustainable development.
Reference:
ACOG (2010), Ethical Considerations for Performing Gynecologic Surgery in Low-Resource Settings Abroad, http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Ethical-Considerations-for-Performing-Gynecologic-Surgery-in-Low-Resource-Settings-Abroad
Bellows, Ben, Rachel Bach, Zoe Baker,Charlotte Warren (2015). Barriers to Obstetric Fistula Treatment in Low-income Countries: A Systematic Review.Nairobi: Population Council.
https://www.popcouncil.org/uploads/pdfs/2014RH_ObstetricFistulaTreatmentSystematicReview.pdf
International Women’s Health Program (2009). A Labour of Loss: Obstetric Fistula http://iwhp.sogc.org/index.php?page=obstetric-fistula
IRIN (2017), Focus on fistula, http://www.irinnews.org/report/89886/kenya-focus-fistula
Ikirimat (2012). Fistula, a Triple Tragedy: The Scourge Destroying Women’s Lives and Dignity, https://www.worldpulse.com/en/community/users/ikirimat/posts/19861
Ghana Health Service (2015). Report on the Assessment of Obstetric Fistula in Ghana http://ghana.unfpa.org/sites/default/files/pub-pdf/Report%20on%20Fistula%20Report%20Burden%20in%20Ghana_Final_1_1_compressed.pdf
Obstetric Fistula : Guiding principles for clinical management and programme development by WHO
Semere L, Nour M. N, (2008). Obstetric Fistula: Living With Incontinence and Shameh, Rev Obstet Gynecol. 2008 Fall; 1(4): 193–197. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621054/
UNFPA (2010). When Childbirth Harms, Obstetric Fistula
https://www.unfpa.org/sites/default/files/resource-pdf/EN-SRH%20fact%20sheet-Fistula.pdf
Women’s Health and Education Center (2012). The Obstetric Fistula in the Developing World, http://www.womenshealthsection.com/content/print.php3?title=urogvvf009&cat=78&lng=english
WHO (2015). Trends in maternal mortality: 1990 to 2015 http://apps.who.int/iris/bitstream/10665/194254/1/9789241565141_eng.pdf
About PPD: Partners in Population and Development is an intergovernmental alliance comprising 26 developing countries. It provides a mechanism for promoting partnership and cooperation among member countries with a view to achieving the goals of the International Conference on Population and Development (ICPD), its Programme of Action and the Sustainable Development Goals. It holds permanent observer status in the General Assembly. The current member countries of the alliance are Bangladesh, Benin, China, Colombia,Egypt, Ethiopia, Gambia, Ghana, India, Indonesia, Jordan, Kenya, Mali, Mexico, Morocco, Nigeria, Pakistan, Senegal, South Africa, Sri Lanka, Thailand, Tunisia, Uganda, Viet Nam, Yemen and Zimbabwe. PPD concerns for 59% of the world population. For more information, visit: www.partners-popdev.org
For further details please contact: Masuma Billah, Partners in Population and Development (PPD), masuma@ppdsec.org