Obstetric Fistulas

(Fistula patients. Photo credit: gigi4791)

The vagina sits between the bladder and the rectum. You already knew that, I hope. But think of the implications. If something - say a difficult childbirth - tears or damages the vagina, it can create a hole between the vagina and the bladder. Or between the vagina and the rectum. Or both.

That's a fistula, that kind of hole. It's every bit as gruesome as it sounds. The damage is done by long labors, especially when the baby is too large for the mother's pelvis. This is common with very young mothers, or anywhere that women give birth without trained assistance. To make things even more depressing, places that women can't access assistance to give birth, are also often places that women can't access care for the fistulas that result.

Addressing the problem of fistulas, like most health issues, requires effort in many parts of the health system. Increasing the age of marriage helps, to prevent pregnancy in girls with hips too immature for safe childbirth.  Improving access to obstetric care makes a difference, by reducing the births that lead to fistula. Finally, trained surgeons can repair fistulas after they occur.

Where do you start? I think this comes down to philosophy. Preventing early marriage has a lot of advantages beyond just preventing fistulas - it encourages women's education, reduces the fertility rate, and empowers women. But no one knows what the best way to prevent early marriage is, and there are no immediate impact interventions for early marriage. Improving access to obstetric care also has impact beyond fistula; it decreases maternal and infant mortality rates. And unlike marriage interventions, we know a lot about making motherhood safer. Finally, repairing fistulas has the most immediate impact. You can rapidly improve the lives of women with fistulas through simple surgery. Addressing fistulas once they occur, however, still leaves a lot of women going through a lot of pain and suffering until they get to a surgeon.