International Day to end obstetric fistula: Awareness is key!
IMAGINE walking into a room and people start sniffing their babies to see if they are the ones producing the foul smell that suddenly permeates the room. Or they open the windows to allow fresh air to come in.
Some even openly point and speak about all the things they think one ‘did wrong’ to be in such a situation.
This is what millions of women who suffer from obstetric fistula go through every day.
While it is the expectation that every woman should be able to celebrate motherhood, not everyone’s journey is rosy as millions die during childbirth or suffer life changing morbidities.
Obstetric fistula is one of the most devastating maternal morbidities stripping women in the developing world of their dignity.
This is an injury which happens during childbirth, resulting in an abnormal opening between the genital tract and the bladder or rectum.
It leaves the woman leaking urine, faeces or both. As the world commemorated the international day to end obstetric fistula yesterday, one issue was apparent; there is not enough awareness around this condition.
Worldwide, an estimated two million women have obstetric fistula and about 50 000 to 100 000 new cases are reported every year.
Most of these cases are exclusively being recorded in Sub-Saharan Africa, Latin America and South Asia.
Obstetric fistula is referred to as a ‘condition for the poor’.
The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour.
Obstetric fistula has been virtually eliminated in industrialised countries through the availability of timely, high-quality medical treatment for prolonged and obstructed labour.
But for the marginalised and poor women and girls, especially those living far from medical services, fistula remains a major cause for concern.
The major drivers of fistula include lack of access to health services, gender inequality, child marriages and adolescent pregnancies which happen before the pelvis is fully developed as well as twin pregnancies, breech position of the baby, malnutrition, small stature and generally poor health conditions.
However, any woman may experience obstructed labour, including older women who have already had babies. If left untreated, experts say obstetric fistula causes chronic incontinence and can lead to a range of other physical ailments including frequent infections, kidney disease, painful sores and infertility.
The physical injuries combined, with misperceptions about the cause of fistula often result in stigma and discrimination, leading to social isolation and psychological harm.
They suffer from depression and suicidal thoughts and other mental health issues.
With no opportunities to eke out a living, the women are driven deeper into poverty and vulnerability. In Zimbabwe, there is a high number of women who suffer from this condition and seeking help.
According to Ministry of Health and Child Care deputy director reproductive health, Dr Lucia Gondongwe, poverty is the main social risk factor for obstetric fistula.
“Obstetric fistula is one of the most devastating injuries of childbirth which leads to women being abandoned or neglected by their partners and families, unable to work and stigmatised by their communities,” she said.
“These women will be secluded from communities and they cannot even go to work and they are lonely.”
Dr Gondongwe said ordinarily, pregnant women should have at least eight antenatal visits where they are checked for any potential life threatening conditions and also educated about the importance of going to the clinic early once labour commences. However, due to various social, cultural and religious beliefs, many women only visit the clinic at the onset of labour or when a home delivery has failed to yield positive results.
And usually at this time, the damage would have already been done.
Dr Gondongwe says the ultimate goal is to drive awareness, so that more women can present early and have safe deliveries in health care institutions where quality of care is at an optimum.
With knowledge comes the means of preventing the avoidable condition.
Women also need to know that treatment opportunities are available.
Up to 95 percent of fistulas can be corrected through surgery.
Government with the support of development partners have been carrying out corrective surgeries which have changed the lives of more than 900 affected women for the better.
The obstetric fistula camps, which were first introduced at Chinhoyi Provincial Hospital in 2015, have been cascaded to four other institutions that include Mashoko Christian Hospital, Morgenster Mission Hospital, Chidamoyo Christian Hospital and Mutambara Mission Hospital to ensure women across the country have access to treatment.
The camps have created room for 29 local obstetricians to undergo a mentorship programme to perform obstetric fistula repairs.
These restorations have restored the smiles of the women and their dignity in their homes and in society.
Prevention
Before women reach treatment stage, there is need to place focus on prevention of obstetric fistula. Access to family planning, skilled birth attendants and emergency obstetric care should be prioritised. There is also need to address societal factors that contribute to fistula such as early marriage and pregnancy.
Dr Gondongwe says ensuring skilled care at all births and providing timely and high quality emergency obstetric care for all women and girls who develop complications during delivery would make this tragic condition as rare in developing countries as it is in the industrialised world.
Zimbabwe has been slowly implementing strategies that may work towards a better access to maternal healthcare and other interventions needed to end fistula.
Funding has been directed to ensuring better maternal, antenatal, neonatal and infant care for all women and this will go a long way in reducing conditions such as obstetric fistula and maternal deaths. This, coupled with community awareness will definitely make ending fistula by 2030 a possibility.
Communities should be aware that delaying the age of first pregnancy, stopping harmful traditional practices and timely access to obstetric care will help to end fistula.
Preventing and managing obstetric fistula will also contribute to the Sustainable Development Goal 3 of improving maternal health care.
This way, no woman will suffer the shame associated with fistula and they will definitely get the care they need.
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