SEATTLE — Approximately 830 women all over the world die every day from pregnancy and childbirth-related injuries, complications and conditions. Obstetric fistula is the most common pregnancy and childbirth-related injury. This condition is most prevalent in sub-Saharan Africa and South Asia, where mothers and their unborn children do not have access to the medical care they need.
What Is Obstetric Fistula?
Obstetric fistula occurs when a woman undergoes an especially long labor period. More than 75 percent of cases see labor that lasts at least three days, with some cases seeing six to seven-day labors. Due to this extended labor, the mother experiences prolonged obstruction, in which the unborn child’s head is pushed against the mother’s pelvic bone during contractions. In between the baby’s head and the mother’s pelvic bone are her bladder, uterine and rectal tissues. The constant pressure and eliminated blood flow causes these tissues to die, resulting in a hole in the tissue. This hole could be between the mother’s bladder and uterus, uterus and rectum, or both.
Where Does This Condition Occur?
Obstetric fistula most often occurs in developing countries, where it is common for women to give birth without access to hospitals or other forms of medical assistance. This injury has been almost completely eradicated in North America, Europe and most developed regions. This is because most birthing mothers in these regions have access to doctors and procedures that can prevent this condition from occurring, as it can usually be prevented with a Caesarean section.
What Are the Medical Effects of Obstetric Fistula?
This condition causes incontinence, or the “constant uncontrollable leaking of urine, feces or both,” according to the text of the Obstetric Fistula Prevention, Treatment, Hope and Dignity Restoration Act of 2018. Other common effects are “frequent bladder infections, painful sores, kidney failure, infertility, foul odor, orthopedic injury, nerve damage that makes normal walking impossible and internal genital scarring that destroys normal sexual function.” Additionally, in 90 percent of pregnancies with obstetric fistula, the baby is stillborn.
What Are the Societal Effects of Obstetric Fistula?
Since this condition often results in incontinence, its sufferers often notice a foul smell that ostracizes them from their families, communities and villages. Often, women with obstetric fistula are rejected by their husbands and excommunicated from their homes. This leads to “depression, anxiety, post-traumatic stress disorder, social isolation and discrimination, suicidal thoughts or actions and lack of adequate economic opportunities, resulting in deepening poverty, isolation and vulnerability.”
Currently, two million women and girls suffer from obstetric fistula, with 50,000 to 100,000 new cases annually, according to the World Health Organization.
Fortunately, there is hope for this condition. Obstetric fistula is extremely preventable with the proper medical care and surgery if necessary. While a Caesarian section can help prevent the injury from occurring in the first place, other surgeries can help cure women who already suffer from it. Obstetric fistula can also be prevented by “alleviating poverty, delaying early marriage and early childbearing, educating and empowering young women, remedying gender and socioeconomic inequalities and addressing malnutrition.”
In order to work toward these resolutions, the U.S. Congress introduced H.R.5068, the Obstetric Fistula Prevention, Treatment, Hope and Dignity Restoration Act of 2018 to the House of Representatives on February 16, 2018. This bill asks that the U.S. government increase aid to foreign mothers, doctors and hospitals, particularly in developing countries, in order to prevent obstetric fistula from occurring.
What Does the Obstetric Fistula Act Ask the Government to Do?
This bill asks for the president to provide assistance to: “(1) address the social, structural, health and human rights issues that lead to obstetric fistula; (2) support treatment of obstetric fistula that includes strengthening the safe surgery and safe anesthesia environment in every country where fistula persists and where obstetric services do not meet an acceptable standard of care; and (3) address and acknowledge the urgency of ensuring that all women who need a Caesarean section are able to have access to such life-saving surgery in a timely, safe, and high-quality care environment.” This assistance can be provided through international organizations, national government aid and other organizations, such as nongovernmental and nonprofits.
Where and How Will the Aid for the Obstetric Fistula Act Be Distributed?
The Obstetric Fistula Act will help prevent the condition by supplying aid to sexual and reproductive health services in a number of nations in which this birth complication is most common, such as a variety of nations in Africa and South Asia. This calls for prenatal and antenatal care, skilled medical professionals accompanying women during labor and birth, emergency mother and newborn care, and high-quality Caesarian sections if necessary.
One of the major goals of the Obstetric Fistula Act, besides preventing the injury, is to provide treatment to those who already suffer from it. This will be done by addressing the need for aid to go toward surgery, anesthesia, healthcare worker education, credentialing, facilities, equipment and healthcare financing.
The aid provided through the Obstetric Fistula Act will also go toward supporting reintegration for women who have this condition, as many have been shunned by their families. This act will also increase aid toward survivors’ education so that they can become self-supportive, especially for those whose families and communities will not welcome them back. Survivors will also receive mental health counseling, among efforts to raise public awareness in their communities to “reduce stigma, exclusion and violence against women and girls with obstetric fistula.”
– Theresa Marino