Obstetric fistula: Woes of women of reproductive age
Obstetric fistula is a problem associated with women of reproductive age. According to studies, in developing countries over 85 per cent of obstetric fistula cases are caused by prolonged labour.
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The condition occurs as a result of prolonged obstructed labour when the head of the baby is not able to pass through the pelvis of the woman. A hole is created between the bladder and the female genetal or the rectum and the female genetal. This causes the woman to leak either faeces and or urine or both through the female genetal.
The condition
This condition, therefore, leaves most of the affected women socially isolated in many communities where they live.
The World Health Organisation (WHO) defines an obstetric fistula as an “abnormal opening between a woman’s genetal organ and bladder and/or rectum through which her urine and/or faeces continually leak”.
In December 2012, the United Nations (UN) General Assembly designated May 23 of each year as the International Day of Fistula. The event is used to create awareness about the condition and how victims could be helped.
Information sourced from the websites of United Nations Population Fund (UNFPA) indicates that “victims of obstetric fistula are women and girls, usually poor, often illiterate who have limited access to health services, including maternal and reproductive health care”.
Social marginalisation
Fistula leads to social marginalisation due to its devastating nature. It is an undeniable fact that on many occasions, women who suffer from fistula have lost their livelihoods, marriages, respect, self-esteem, and even sex from their partners.
It is sad to mention that obstetric fistula continues to remain a constant cause of misery to women of childbearing age because of the continuous leaking of urine or faeces and the constant wetting of their clothes which produce disagreeable smell.
There are different forms of fistulae. They include Vesico-Vaginal Fistula (VVF), Recto-Vaginal Fistula (RVF) and combinations of VVF and RVF fistulae.
It must be noted that while the most common cause of obstetric is obstructed and/or prolonged labour some pertinent factors such as poverty, lack of awareness, poor-health seeking behaviours, poor health and referral systems, poor transportation networks, scarcity of skilled birth attendants and inadequate obstetric care services (infrastructure) also contribute to its occurrence.
Because of the stigma attached to obstetric fistula, many women suffering from the condition feel shy to seek medical intervention or report it at health facilities, thus making it difficult to determine the actual prevalence rate in the country.
Misconception
In some communities, obstetric fistula is seen as a punishment for evil doers or as a result of a curse. Others, however, believe that the condition is caused by evil manipulations and so choose to seek help at prayer centres.
Information sourced from www.fistulafoundation.org indicates that “more than 75 per cent of women with obstetric fistula have endured labour that lasted three days or more”.
It adds that obstetric fistula most commonly occurs among women who live in low-resource countries, who give birth without access to medical help, thereby resulting in obstructed labour.
Although currently there is no reliable data on the prevalence of fistula, the WHO estimates that at least two to three million women and girls live with fistula while an additional 50,000 to 100,000 new cases are recorded each year in the developing countries.
According to the Global Fistula Map (GFM) that collates reports on fistula reports, between 2010 and 2013, only 60,280 women received fistula repair surgery; about 15,000 per year, on average.
Encouragement
In an interview with the Daily Graphic, a former Northern Regional Director of the Department of Gender, Mr I.P.S Zakaria-Saa, encouraged women suffering from fistula to seek early medical attention since its treatment is free.
He said fistula was one of the common factors causing the breakdown of marriages in most rural parts of northern Ghana.
He, therefore, implored women suffering from the condition not to feel shy to seek early treatment, explaining that fistula was a health condition and not a disease as seen by many uninformed persons who considered the condition as a disease, curse from the gods and/or punishment for being a witch.
Regional data
According to the 2015 report on the Burden of Obstetric Fistula in Ghana conducted by the Ghana Health Service (GHS) in collaboration with the UNFPA, fistula occurred in all the 10 regions of the country.
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According to District Health Management Information Systems (DHIMS), a total of 1,538 fistula cases were seen in health facilities from all the 10 regions of the country from January 2011 to July 2014.
Out of the reported cases, only 616 women had their fistula repaired.
Further analysis of the reported cases indicated that the Upper East Region had the highest percentage of VVF repair (84.0 per cent), followed by Western Region (76.2 per cent), Central Region (73.6 per cent), Upper West Region (66.3), and Volta Region (54.3 per cent).
Greater Accra recorded 28 cases from January 2011 to July 2014; out of which 21.4 per cent had their fistula fixed.
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In the Northern and Brong Ahafo regions respectively, a total of 527 and 46 patients with VVF were seen at the health facilities, out of which 30.4 per cent and 10.9 per cent were surgically repaired.
Ashanti Region recorded the smallest percentage of VVF repairs. For instance, out of the 295 VVF patients seen at the health facilities between 2011 and 2014, only seven patients got their fistula repaired, representing 2.4 per cent.
Awareness
Obstetric fistula is one of the most disturbing medical infirmities affecting women mostly in the developing countries such as Ghana due to complications arising from lack of surgical intervention for prolonged labour. It is considered as one of the most serious injuries of childbearing.
It is worth noting that with skilled attendance at birth and timely access to emergency obstetric care, these devastating injuries can be prevented, and in most cases, treated because according to a report on the assessment of obstetric fistula in Ghana conducted by the GHS in June 2015, “fistula can be repaired through surgery and can yield a success rate of over 90 per cent when carried out by a trained provider with the proper medical equipment”.
Writer’s email: [email protected]
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