Obstetric fistula is a childbirth injury that affects girls and women almost exclusively in resource-poor settings of Africa and South Asia. It results from an especially difficult childbirth and leaves women unable to control urine and feces. Vesico-vaginal fistula (“VVF”) is a hole that develops between the vagina and the bladder, and recto-vaginal fistula (“RVF”) is a hole that develops between the vagina and the rectum.
Both VVF and RVF are the result of prolonged obstructed labor when a woman is unable to delivery her baby safely and cannot access a cesarean section. The constant pressure of the baby’s head against the mother’s pelvic bone causes the tissues to disintegrate between the vagina and the bladder and/or between the vagina and the rectum.
The baby almost always dies as a result of the long labor, and the mother is left leaking urine and/or feces uncontrollably from the vagina. In addition, fistula can lead to ulceration of the genital area. It may also cause a condition known as “foot drop,” which makes it difficult or impossible for women to walk due to extreme nerve damage to the lower limbs. Beyond these physical consequences, fistula often exacts a severe social toll, resulting in divorce or abandonment and varying degrees of social isolation. It is not uncommon for women with fistula to work alone, eat alone, and sleep alone.
Fistula can be cured. Fistula repair surgery, when carried out by a trained provider with the proper medical equipment and supplies, can yield success rates of over 90%. The biggest challenge faced by many women with fistula is reaching a health facility that has a surgeon trained in fistula repair. Countries with a high rate of fistula tend to have shortages of trained health care providers and health facilities overall and typically have only a few doctors (if any) trained in fistula repair.
Written by: Maggie Bangser and Kristina Graff