Let's fight fistula, now more than ever

19May 2020
The Guardian
Let's fight fistula, now more than ever

The fight to end obstetric fistula, one of the most serious and tragic injuries that can occur during childbirth, could be threatened by the current pandemic of COVID-19.

Women with fistula are often shunned by their communities. The United Nations has observed the International Day to End Obstetric Fistula since 2013. The day, 23 May, is meant to raise awareness of this issue and mobilise support around the globe. Hundreds of thousands of women and girls in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are living with this injury.  Women who experience this preventable condition suffer constant urinary incontinence, which often leads to social isolation, skin infections, kidney disorders and even death if left untreated.  A surgery can repair the injury with success rates as high as 90 per cent for less complex cases.

Obstetric fistula is preventable; it can largely be avoided by delaying the age of first pregnancy; the cessation of harmful traditional practices; and timely access to obstetric care. Unfortunately, the current pandemic affects all these preventive measures in developing countries where obstetric fistula still exists - countries in which health care systems, even before the coronavirus outbreak, failed to provide accessible, quality maternal health care.

Due to COVID-19, it is expected that 13 million more child marriages could take place by 2030 than would have otherwise. Families are more likely to marry off daughters to alleviate the perceived burden of caring for them, especially in the anticipated economic fallout of the pandemic.

The pandemic is also expected to cause significant delays in programmes to end female genital mutilation (FGM) - something that could lead to a spike in FGM cases, according to UNFPA, which is a contributing factor for obstetric fistula.

As the virus advances in these countries, health services become overloaded, or provide a limited set of the services that women need. At the same time, many women and girls also skip important medical check-ups for fear of contracting the virus.

With this possible future scenario of preventive measures in danger, now more than ever, it is important to call on the international community to use the International Day to End Obstetric Fistula to significantly raise awareness and intensify actions towards ending obstetric fistula, as well as urging post-surgery follow-up and tracking of fistula patients.

Maternal health indicators have been improving in Tanzania, but there is still a long way to go. In cities, nearly all women deliver in hospitals—but over 70 per cent of the Tanzanian population lives in rural areas, where health care remains difficult to access.

In Tanzania women with fistula suffer for eight years on average before finding help. During that time, they experience significant emotional trauma—too often, fistula survivors are shunned by their communities and abandoned by their husbands. Due to the isolating nature of fistula, many Tanzanian survivors do not know that their condition is treatable, and blame themselves for their misfortune or believe that they are cursed.

As many as 3,000 Tanzanian women develop obstetric fistula each year, a condition that leaves them incontinent, leaking urine and/or faeces uncontrollably. As a result, they are often excluded from their families and communities.

Obstetric fistula is a childbirth injury caused by prolonged, obstructed labour. It occurs when pressure from the baby’s head compresses the mother’s soft tissue in the birth canal, which obstructs blood flow. Without blood, the tissues die and a hole forms between the bladder and the vagina or the rectum and the vagina.

To help remove barriers to treatment, CCBRT covers the cost of all obstetric fistula patients’ treatment, accommodation and meals throughout their course of care. CCBRT also supports 6 partner hospitals in Tanzania to provide treatment, making fistula care more accessible for all Tanzanian women. In 2016, CCBRT and its partner facilities performed 1,012 fistula surgeries.

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