Obstetric fistula - Knowledge

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wards, and anesthetic services. Physiotherapy and social-reintegration services are also necessary to arm women affected by obstetric fistula with the tools necessary to re-enter a society from which they have been ostracised. The size of the facility should be tailored to the need in the area, and the most successful centers work in collaboration with other treatment centers and organizations, forming a larger network of resources. The cost of salaries, single-use medical equipment, up to date technology and equipment, and maintenance of infrastructure, collectively provide large economic burdens to treatment centers. A barrier also arises when governments and local authorities require that approval be obtained prior to the construction of centers. There is an uneven distribution of specialized health care providers due to the below optimal training and supervision of health works and the low wages of fistula surgeons. Most fistula surgeons come from developed countries and are brought to developing countries, the nations more often affected by fistula, by a variety of organizations. An example of a well functioning treatment center is in Bangladesh where a facility has been created in association with the Dhaka Medical College Hospital with support from the United Nations Population Fund. Here, 46 doctors and 30 nurses have been trained and have successfully doubled the number of fistula cases addressed and operated on. Another example is a fistula unit in N'djamena, Chad, which has a mobile clinic that travels to rural, hard-to-reach areas, to provide services, and works in association with Liberty Hospital. The World Health Organization has created a manual articulating necessary principles for surgical and pre- and post- operative care regarding obstetric fistula, providing a beneficial outline for affected nations. Treatment centers are crucial for the survival of obstetric fistula patients and well-equipped centers help the emotional, physical, and psychological aspects of their lives.

631:, promoting the practice of spacing between births, supporting women in education, and postponing early marriage. Fistula prevention also involves many strategies to educate local communities about the cultural, social, and physiological factors of that condition and contribute to the risk for fistulae. One of these strategies involves organizing community-level awareness campaigns to educate women about prevention methods such as proper hygiene and care during pregnancy and labor. Prevention of prolonged obstructed labor and fistulae should preferably begin as early as possible in each woman's life. For example, improved nutrition and outreach programs to raise awareness about the nutritional needs of children to prevent malnutrition, as well as improve the physical maturity of young mothers, are important fistula prevention strategies. It is also important to ensure access to timely and safe delivery during childbirth: measures include availability and provision of emergency obstetric care, as well as quick and safe cesarean sections for women in obstructed labor. Some organizations train local nurses and midwives to perform emergency cesarean sections to avoid vaginal delivery for young mothers who have underdeveloped pelvises. Midwives located in the local communities where obstetric fistulae are prevalent can contribute to promoting health practices that help prevent future development of obstetric fistulae. NGOs also work with local governments, like the government of 553:. This can cause a development of unplanned complications that may arise during home births, in which traditional techniques are used. These techniques often fail in the event of unplanned emergencies, leading women to go to the hospital for care too late, desperately ill, and therefore vulnerable to the risks of anesthesia and surgery that must be used on them. In a study of women who had prenatal care and those who had unbooked emergency births, "the death rate in the booked-healthy group was as good as that in many developed countries, the death rate in the unbooked emergencies was the same as the death rate in England in the 16th and 17th centuries." In this study, 62 unbooked emergency women were diagnosed with obstetric fistulae out of 7,707 studied, in comparison to three diagnosed booked mothers out of 15,020 studied. In addition, studies find that education is associated with lower desired family size, greater use of contraceptives, and increased use of professional medical services. Educated families are also more likely to be able to afford health care, especially maternal healthcare. 32: 533:. Sub-Saharan Africa is one such environment where the shortest women have on average lighter babies and more difficulties during birth when compared with full-grown women. This stunted growth causes expectant mothers to have skeletons unequipped for proper birth, such as an underdeveloped pelvis. This weak and underdeveloped bone structure increases the chances that the baby will get stuck in the pelvis during birth, cutting off circulation and leading to tissue necrosis. Because of the correlation between malnutrition, stunted growth, and birthing difficulties, maternal height can at times be used as a measure for expected labor difficulties. 376:, most citizens do not believe an obstetric fistula to be a medical condition, but as a divine punishment or a curse for disloyal or disrespectful behavior. Other sub-Saharan cultures view offspring as an indicator of a family's wealth. A woman who is unable to successfully produce children as assets for her family is believed to make her and her family socially and economically inferior. A patient's incontinence and pain also render her unable to perform household chores and childrearing as a wife and as a mother, thus devaluing her. Other misconceptions about obstetric fistulae are that they are caused by 389:

capable or allowed to participate in traditional activities, including the duties of wife and mother. Because such consequences highly stigmatize and marginalize the woman, the intense loneliness and shame can lead to clinical depression and suicidal thoughts. Some women have formed small groups and resorted to walking to seek medical help, where their characteristic odor makes them a target for sub-Saharan predatory wildlife, further endangering their lives. This trip can take on average 12 hours to complete. Moreover, women are sometimes forced to turn to

868:, which traced the journey of five women from Ethiopia who sought treatment for their obstetric fistulae at the Addis Ababa Fistula Hospital in Ethiopia. The film still airs frequently on PBS in the U.S. and is credited with increasing awareness of obstetric fistulae greatly. Increased public awareness and corresponding political pressure have helped fund the UNFPA's Campaign to End Fistula, and helped motivate the United States Agency for International Development to dramatically increase funding for the prevention and treatment of obstetric fistulae. 652: 706:, two medical centers treat fistula patients. In Nigeria, more dedicated health professionals operate on up to 1,600 women with a fistula per year. The world is currently severely under capacity for treating the problem; it would take up to 400 years to treat the backlog of patients. To prevent any new cases of obstetric fistulae, about 75,000 new emergency obstetric care facilities would have to be built in Africa alone, plus an increase in financial support and an even higher number of certified doctors, midwives, and nurses needed. 779:(WHO), an estimated 50,000 to 100,000 women develop obstetric fistulae each year and over two million women currently live with an obstetric fistula. In particular, most of the two million-plus women in developing nations who develop obstetric fistulae are under the age of 30. Between 50 and 80% of women under the age of 20 in poor countries develop obstetric fistulae (the youngest patients are 12–13 years old). Other estimates indicate about 73,000 new cases occur per year. 681:

300–450. Initial surgeries done by inadequately trained doctors and midwives increase the number of follow-up surgeries that must be performed to restore full continence. Successful surgery enables women to live normal lives and have more children, but it is recommended to have a cesarean section to prevent the fistula from recurring. Postoperative care is vital to prevent infection. Some women are not candidates for this surgery due to other health problems. In those cases,

3580: 4723: 883:, including Tanzania, Democratic Republic of Congo, Sudan, Pakistan, Bangladesh, Burkina Faso, Chad, Mali, Uganda, Eritrea, Niger, and Kenya. Laws to increase the minimum age for marriage have also been enacted in Bangladesh, Nigeria, and Kenya. To monitor these countries and hold them accountable, the UN has developed six "process indicators", a benchmark tool with minimum acceptable levels that measures whether or not women receive the services they need. 922:

as the federal and state governments of Nigeria, 13 Nigerian fistula surgeons, the Nigerian Red Cross, and UNFPA. During the nine-month preparation period, facilities were renovated, equipment were provided, and staff were extensively trained to treat fistula. The goals of this initiative were to alleviate the backlog of patients waiting for surgery, provide treatment services at host sites, and to raise awareness for maternal health.

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Partners in this initiative include Columbia University's Averting Maternal Death and Disability Program, the International Federation of Gynecology and Obstetrics, and the World Health Organization. The official international partnership formed by the Campaign to End Fistula is named the Obstetric Fistula Working Group (OFWG) and its purpose is to coordinate and collaborate global efforts to eliminate obstetric fistulae.

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develop are three-fold: prevention of new cases, treatment for patients, and support for reintegration into society after the operation. Prevention efforts include access to maternal health services and mobilizing communities and legislators to increase awareness of maternal health problems. Training health providers and ensuring affordable treatment services, as well as providing social services such as

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who develop complications, and repairing physical damage through medical intervention and emotional damage through counselling." One of the UNFPA's initiatives to reduce the cost of transportation in accessing medical care provided ambulances and motorcycles for women in Benin, Chad, Guinea, Guinea-Bissau, Kenya, Rwanda, Senegal, Tanzania, Uganda, and Zambia.

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countries produce higher maternal mortality rates and thus higher obstetric fistula rates. Furthermore, impoverished countries not only have low incomes, but also lack adequate infrastructure, trained and educated professionals, resources, and a centralized government that exist in developed nations to effectively eradicate obstetric fistulae.

818:, warning the physician against trying to cure it, saying, "prescription for a woman whose urine is in an irksome place: if the urine keeps coming and she distinguishes it, she will be like this forever." This seems to be the oldest reference to vesicovaginal fistula, one which articulates the storied history of the problem. 414:

on her own. In a study of The lived experience of Malawian women with obstetric fistula, the immense psychological trauma is addressed: "For these women, internalizing this constant struggle leads to psychological morbidity." It was striking how many women discussed constant sadness and giving up hope in their interviews."

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addition, access to health services and education – including family planning, gender equality, higher living standards, child marriage, and human rights – must be addressed to reduce the marginalization of women and girls. Reducing marginalization in these areas could reduce maternal disability and death by at least 20%.

364:, which can each lead to death. Further, only a quarter of women who develop a fistula in their first birth are able to have a living baby, and therefore have minuscule chances of conceiving a healthy baby later on. Some, due to obstetric fistulae and other complications from childbirth, do not survive. 925:

The Fistula Fortnight treated 569 women at no cost, with an 87.8% rate of successful closures. Follow-up treatments and services were provided, such as bed rest, analgesics, oral fluids, visual monitoring of urination by nurses, a catheter, catheter removal, and an examination and discharge from the

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The Fistula Fortnight was a two-week initiative that took place from February 21 to March 6, 2005, where fistula experts treated fistula patients for free at four surgical camps in the northern Nigerian states of Kano, Katsina, Kebbi, and Sokoto. The initiative was collaborated by many partners such

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In developing countries, women who are affected by obstetric fistulae do not necessarily have full agency over their bodies or their households. Rather, their husbands and other family members have control in determining the healthcare that the women receive. For example, a woman's family may refuse

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often suffer from a severe burden and breakdown within the healthcare system. This breakdown puts many people at risk, specifically women. Many hospitals within these conditions have shortages of staff, supplies, and other forms of medical technology that would be necessary to perform reconstructive

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produces such high rates of fistula cases is the malnutrition that exists in such areas. Lack of money and access to proper nutrition, as well as vulnerability to diseases that exist in impoverished areas because of limited basic health care and disease prevention methods, cause inhabitants of these

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According to UNFPA, "Generally accepted estimates suggest that 2.0-3.5 million women live with obstetric fistulae in the developing world, and between 50,000 and 100,000 new cases develop each year. All but eliminated from the developed world, obstetric fistula continues to affect the poorest of the

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and social isolation that result from obstetric fistulae eliminate all other income opportunities. With only 7.5% of women with fistulae able to access treatment, the vast majority of women end up with the consequences of obstructed and prolonged labor simply because options and access to help is so

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Besides physical treatment, mental health services are also needed to rehabilitate fistula patients, who experience psychological trauma from being ostracized by the community and from fear of developing fistulae again. A study on the first formal counseling program for fistula survivors in Eritrea

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Several organizations have developed effective fistula prevention strategies. One, the Tanzanian Midwives Association, works to prevent fistulae by improving clinical healthcare for women, encouraging the delay of early marriages and childbearing years, and helping the local communities to advocate

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received and having one less person to feed in the family helps alleviate the financial burdens of the bride's family. Early marriages lead to early childbirth, which increases the risk of obstructed labor, since young mothers who are poor and malnourished may have underdeveloped pelvises. In fact,

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fistula is not only debilitating physically, but emotionally. A woman is presented with an array of psychological trauma that she must oftentimes deal with herself unless provided with ample resources. Oftentimes ostracized by her community, a woman with obstetric fistula tends to face these issues

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The most direct consequence of an obstetric fistula is the constant leakage of urine, feces, and blood as a result of a hole that forms between the vagina and bladder or rectum. This leaking has both physical and societal penalties. The acid in the urine, feces, and blood causes severe burn wounds

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Obstetric fistulae have far-reaching physical, social, economic, and psychological consequences for the women affected. According to UNFPA, "Due to the prolonged obstructed labour, the baby almost inevitably dies, and the parent is left with chronic incontinence. Unable to control the flow of urine

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The UNFPA set out several strategies to address fistulae, including "postponing marriage and pregnancy for young girls, increasing access to education and family planning services for women and men, provide access to adequate medical care for all pregnant women and emergency obstetric care for all

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Adequate population-based epidemiological data on obstetric fistulae are lacking due to the historic neglect of this condition since it was mostly eradicated in developed nations. Available data are estimations that should be viewed with caution. About 30% of women over age 45 in developed nations

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is recommended because it has a balloon to hold it in place. The indwelling Foley catheter drains urine from the bladder. This decompresses the bladder wall so that the wounded edges come together and stay together, giving it a greater chance of closing naturally, at least in the smaller fistulae.

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Poverty hinders women from being able to access normal and emergency obstetric care because of long distances and expensive procedures. For some women, the closest maternal care facility can be more than 50 km away. In Kenya, a study by the Ministry of Health found that the "rugged landscape,

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A complete fistula treatment center includes investigative services like laboratory work, radiology, and a blood bank, to ensure that the medical history of patients is clearly understood before treatment options are evaluated. The surgical services would include operating theaters, postoperative

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Prevention is the key to ending fistulae. UNFPA states that, "Ensuring skilled birth attendance at all births and providing emergency obstetric care for all women who develop complications during delivery would make fistula as rare in developing countries as it is in the industrialized world." In

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Other organizations also help to arrange mission trips for medical personnel to visit countries with women affected by fistulae, perform surgeries, and train local doctors to give medical assistance for fistula patients. The International Organization for Women and Development (IOWD) is one such

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To date, the Campaign to End Fistula has involved more than 30 countries in sub-Saharan Africa, South Asia, and the Middle East, and completed rapid needs assessments in many of those countries to continually assess the needs in each country. The strategies that the campaign helps each nation to

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Promoting education for girls is also a key factor to preventing fistulae in the long term. Former fistula patients often act as "community fistula advocates" or "ambassadors of hope", a UNFPA-sponsored initiative, to educate the community. These survivors help current patients, educate pregnant

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or an infection in the birth canal. The unavoidable odor is viewed as offensive, thus their removal from society is seen as essential. Accounts of women who develop obstetric fistulae proclaim that their lives have been reduced to the leaking of urine, feces, and blood because they are no longer

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was discovered in a mummy from the Theban acropolis. This papyrus, 65 feet long, 14 inches wide, consisting of 108 columns each about 20 lines, now resides in the library at the University of Leipzig. The gynecological reference in this papyrus addresses uterine prolapse, but at the end of page

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The first acknowledgments of obstetric fistula date back to various Egyptian documents known as the papyri. These documents, including rare medical engravings, were found of the entrance of a tomb located in the necropolis of Saqquarah, Egypt. The tomb belonged to an unknown physician who lived

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Another challenge is the lack of trained professionals to provide surgery for fistula patients. As a result, nonphysicians are sometimes trained to provide obstetric services. For example, the Addis Ababa Fistula Hospital has medical staff without formal degrees, and one of its top surgeons was

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is the main indirect cause of obstetric fistulae around the world. As obstructed labor and obstetric fistulae account for 8% of maternal deaths worldwide and "a 60-fold difference in gross national product per person shows up as a 120-fold difference in maternal mortality ratio," impoverished

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As a result, many girls are divorced or abandoned by their husbands and partners, disowned by family, ridiculed by friends, and even isolated by health workers. Divorce rates for women who have an obstetric fistula range from 50% to as high as 89%. Now marginalized members of society, girls are

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The Addis Ababa Fistula Hospital in Ethiopia successfully treats women with obstetric fistulae, even in less than desirable environments. As a result, the UNFPA gathered partners in London in 2001, and officially launched an international initiative to address obstetric fistulae later in 2003.

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Another challenge standing between women and fistula treatment is information. Most women have no idea that treatment is available. Because this is a condition of shame and embarrassment, most women hide themselves and their condition and suffer in silence. In addition, after receiving initial

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Treatment is available through reconstructive surgery. Primary fistula repair has a 91% success rate. The corrective surgery costs about US$ 100–400, and the cost for the entire procedure, which includes the actual surgery, postoperative care, and rehabilitation support, is estimated to cost $

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People recovering from a fistula in the postoperative period need support to fully reintegrate into society. In particular, physical labor is limited in the first year of recovery, so women need alternative ways to earn an income. Since poverty is an indirect cause of obstetric fistulae, some

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The initiative's first action was to quantitatively assess the issue in countries where the prevalence is suspected to be high, including nine countries in sub-Saharan Africa. The studies found that fistula patients are mostly illiterate, young, and poor women. Moreover, local legislators and

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Challenges with regards to treatment include the very high number of women needing reconstructive surgery, access to facilities and trained surgeons, and the cost of treatment. For many women, US$ 300 is a price they cannot afford. Access and availability of treatment also vary widely across

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were adopted after the United Nations Millennium Summit to be achieved by 2015. The fifth goal of improving maternal health is directly related to obstetric fistula. Since 2003, obstetric fistula has been gaining awareness amongst the general public and has received critical attention from

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About 37% of obstetric fistulae that are treated within 75 days after birth with a Foley catheter resolve. Even without preselecting the least complicated obstetric fistula cases, a Foley catheter by midwives after the onset of urinary incontinence could treat over 25% of all new fistulae.

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long distances to health facilities, and societal preferences for delivery with a traditional birth attendant contributed to delays in accessing necessary obstetric care." Emergency cesarean sections, which can help avoid fistulae caused by prolonged vaginal deliveries, are very expensive.

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on the legs from the continuous dripping. Nerve damage that can result from the leaking can cause women to struggle with walking and eventually lose mobility. In an attempt to avoid the dripping, women limit their intake of water and liquid, which can ultimately lead to dangerous cases of

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Although the psychological impacts center around the woman experiencing the fistula, others around them, and especially loved ones, feel the impact as well. The same study references this: "This attitude was often shared by their family members, both husbands and female relatives."

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found that 54.8% of the women affected were under 20 years of age, and 64.4% gave birth at home or in poorly equipped local clinics. When available at all, cesarean sections and other medical interventions are usually not performed until after tissue damage has already been done.

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medical examinations for the patient by male doctors, but female doctors may be unavailable, thus barring women from prenatal care. Furthermore, many societies believe that women are supposed to suffer in childbirth, thus are less inclined to support maternal health efforts.

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hospital at a minimum of four weeks, with instruction to avoid sexual intercourse. The Fistula Fortnight also had preoperative and postoperative counseling provided by nurses and social workers and held health education workshops for fistula patients and their families.

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Some common psychological consequences that women with a fistula face are the despair from losing their child, the humiliation from their smell, and inability to perform their family roles. Additionally, a fear of developing another fistula in future pregnancies exists.

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nonprofit organization. The IOWD hosts four to five mission trips per year to provide relief to obstetric fistula patients in West Africa. IOWD mission trip members have evaluated thousands of patients at no cost and performed surgeries for over a thousand women.

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Sankare I. Contribution to the development of a mechanism for autonomous social for women with fistula in the region of Mopti. Proceedings of the meeting making motherhood safer by addressing obstetric fistula. Johannesburg, South Africa, 23—26 October;

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and mental health services, help treat and reintegrate women into their communities. Other tasks undertaken by the campaign include fundraising and introducing new donors and gathering new partners of all perspectives, such as faith-based organizations,

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The nature of the injury varies depending on the size and location of the fistula, so a surgeon with experience is needed to improvise on the spot. Before the person undergoes surgery, treatment and evaluation are needed for conditions including

794:. The rate of obstetrical fistulae is much lower in places that discourage early marriage, encourage and provide general education for women, and grant women access to family planning and skilled medical teams to assist during childbirth. 689:

shows positive results, whereby counseling significantly improved the women's self-esteem, knowledge about fistulae and fistula prevention, and behavioral intentions for "health maintenance and social reintegration" following surgery.

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During most of the 20th century, obstetric fistulae were largely missing from the international global health agenda. This is reflected by the fact that the condition was not included as a topic at the landmark United Nations 1994

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Women with obstetric fistula face severe mental health issues. Among women with obstetric fistula from Bangladesh and Ethiopia 97% screened positive for potential mental health dysfunctions and about 30% had major depression.

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Kadiatou K. Prevention of obstetric fistula and support to women identified in Se´gou, Mali. proceedings of the meeting making motherhood safer by addressing obstetric fistula. Johannesburg, South Africa, 23—26 October;

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United Nations Population Fund (UNPFA) & EngenderHealth (2003). Obstetric fistula needs assessment report: Findings from nine African countries. Retrieved from www.unfpa.org/fistula/docs/fistula-needsassessment.pdf

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different sub-Saharan countries. Certain regions also do not have enough maternal care clinics that are equipped, willing to treat fistula patients, and adequately staffed. At the Evangelical Hospital of Bemberéke in

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mothers, and dispel cultural myths that obstetric fistulae are caused by adultery or evil spirits. Successful ambassador programs are in place in Kenya, Bangladesh, Nigeria, Ghana, Côte d'Ivoire, and Liberia.

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Even women who do make it to the hospital may not get proper treatment. Countries that suffer from poverty, civil and political unrest or conflict, and other dangerous public health issues such as

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government officials' lack of awareness exacerbate the problem. The OFWG improves awareness for prenatal and neonatal care and develops strategies for clinically managing obstetric fistula cases.

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Arrowsmith S, Hamlin EC, Wall LL (September 1996). "Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world".

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or faeces, or both, they may be abandoned by their spouse and family and ostracized by their community. Without treatment, their prospects for work and family life are virtually nonexistent."

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The ACQUIRE Project. Traumatic gynecologic fistula as a consequence of sexual violence in conflict settings: a literature review. New York7 The ACQUIRE Project/EngenderHealth; 2005.

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obstetric fistula repair. There is a shortage of doctors in rural Africa, and studies find that the doctors and nurses who do exist in rural Africa often do not show up for work.

568:(usually between the ages of 9 and 15). Social factors and economic factors contribute to this practice of early marriages. Socially, some grooms want to ensure their brides are 702:, only one expatriate volunteer obstetrics and gynecology doctor is available a few months per year, with one certified nurse and seven informal hospital workers. In all of 786:, including giving birth at local hospitals rather than at home, which dramatically reduced rates of obstructed labor and obstetric fistulae in Europe and North America. 5597: 3236:

Ramsey K, Iliyasu Z, Idoko L (November 2007). "Fistula Fortnight: innovative partnership brings mass treatment and public awareness towards ending obstetric fistula".

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very tightly, cutting off blood flow to the surrounding tissues between the vagina and the rectum and between the vagina and the bladder, causing the tissues to

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and forceps. Primary risk factors include early or closely spaced pregnancies and lack of access to emergency obstetric care. For example, a 1983 study in

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Diagram of maternal and foetal sequelae of prolonged obstructed labour, highlighting areas that are at high risk of developing obstetric fistula(s).

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Wegner MN, Ruminjo J, Sinclair E, Pesso L, Mehta M (November 2007). "Improving community knowledge of obstetric fistula prevention and treatment".

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Narcisi L, Tieniber A, Andriani L, McKinney T (2010). "The fistula crisis in sub-Saharan Africa: an ongoing struggle in education and awareness".

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Obstetric fistulae were very common throughout the world, but since the late 19th century, the rise of gynecology developed safe practices for

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Hilton P, Ward A (1998). "Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years' experience in southeast Nigeria".

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community organizations aim to provide postoperative services to enhance the women's socioeconomic situation. Delta Survie, located in Mopti,

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when a cesarean section cannot be obtained. Over the course of the three to five days of labor, the unborn child presses against the mother's

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Waaldjik K (1998) Evaluation report XIV on VVF projects in northern Nigeria and Niger. Katsina (Nigeria): Babbar Ruga Fistula Hospital. 27 p.

854:, a Pulitzer Prize–winning writer, wrote several columns in 2003, 2005, and 2006 focusing on fistula and particularly treatment provided by 2796: 3569: 3455: 496:, lack of education, early marriage and childbirth, the role and status of women in developing countries, harmful traditional practices, 2976:"The second meeting of the working group for the prevention and treatment of obstetric fistula, Addis Ababa, 30 October–1 November 2002" 4645: 331:", which is the paralysis of the lower limbs caused by nerve damage, making it impossible to walk, infection of the fistula forming an 3087: 1723: 1191: 3441: 2048:

Pope R, Bangser M, Requejo JH (2011). "Restoring dignity: social reintegration after obstetric fistula repair in Ukerewe, Tanzania".

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Wall LL, Arrowsmith SD, Briggs ND, Browning A, Lassey A (July 2005). "The obstetric vesicovaginal fistula in the developing world".

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Other effects of obstetric fistulae include stillborn babies due to prolonged labor, which happens 85% to 100% of the time, severe

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Polan ML, Sleemi A, Bedane MM, Lozo S, Morgan MA (2015). Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN (eds.).

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Physical consequences of obstetric fistulae lead to severe sociocultural stigmatization for various reasons. For example, in

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to the affected area for a prolonged period of time. Diagnosis is generally based on symptoms and may be supported by use of

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UNFPA. The second meeting of the Working Group for the Prevention and Treatment of obstetric fistula. New York: UNFPA; 2003.

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during the 6th dynasty. The translation of this document became possible with the discovery of the Rosetta stone in 1799.

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Social, political, and economic causes that indirectly lead to the development of obstetric fistulae concern issues of

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forced to live on the edges of their villages and towns, often in isolation in a hut where they will likely die from

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Ahmed S, Holtz SA (November 2007). "Social and economic consequences of obstetric fistula: life changed forever?".

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Ahmed S, Holtz SA (November 2007). "Social and economic consequences of obstetric fistula: life changed forever?".

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Charlotte Warren; Annie Mwangi (December 2008). "Obstetric Fistula: Can Community Midwives Make a Difference?".

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Capes T, Ascher-Walsh C, Abdoulaye I, Brodman M (2011). "Obstetric fistula in low and middle income countries".

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Kenya Ministry of Health and UNFPA. Needs assessment of obstetric fistula in selected districts of Kenya; 2004.

837:(ICPD). The 194-page report from the ICPD does not include any reference to obstetric fistulae. In 2000, eight 4687: 4655: 4553: 2982: 910: 862:, Engel Entertainment, and a number of other organizations including PBS NOVA released the documentary film, 4632: 4548: 3886: 1774: 838: 377: 5513: 5042: 4161: 4104: 3668: 718:

illiterate, but she had been trained over years and now regularly successfully performs fistula surgery.

2020:. The International Organization for Women and Development. Lecture presented October 2006, Phoenix, AZ. 5508: 5241: 4938: 4727: 4692: 4682: 3722: 3604: 3555: 1442:

Wall LL (September 2006). "Obstetric vesicovaginal fistula as an international public-health problem".

454: 824:, in 1852 in Alabama, developed an operation for fistula. He worked at the New York Women's Hospital. 5557: 5126: 4485: 4355: 4313: 4174: 2202: 776: 677:. Quality treatment in low-resource settings are possible (as in the cases of Nigeria and Ethiopia). 5074: 3193: 4893: 4697: 4221: 4037: 4004: 3896: 3530: 5441: 5391: 5347: 5005: 4650: 4504: 4296: 3989: 1763:

Burkina Faso Ministry of Health and UNFPA. Sociocultural study on obstetric fistula. Ouagadougou.

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Cook RJ, Dickens BM, Syed S (October 2004). "Obstetric fistula: the challenge to human rights".

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High levels of poverty also lead to low levels of education among impoverished women concerning

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poor: women and girls living in some of the most resource-starved remote regions in the world."

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have the condition, with about 75,000 new cases developing a year. It occurs very rarely in the

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In the developed world, such as the US, the primary cause of obstetric fistulae, particularly

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Evidence of obstetric fistula dates back to 2050 BCE, when Queen Henhenit had a fistula.

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Hamlin EC, Muleta M, Kennedy RC (March 2002). "Providing an obstetric fistula service".

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Patients at the Addis Ababa Fistula Hospital in Ethiopia are all treated free of charge.

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Fistula women of Africa: The horror of their lives, and hope for their tomorrow

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In less-developed countries, obstetric fistulae usually develop as a result of

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when they get married, so an earlier marriage is desirable. Economically, the

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have begun adopting policies and creating task forces to address issues of

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Essential Surgery: Disease Control Priorities, Third Edition (Volume 1)

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Half the Sky: Turning Oppression into Opportunity for Women Worldwide

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obstructed labor is responsible for 76 to 97% of obstetric fistulae.

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Evidence and Information for Policy (EIP), World Health Organization

545:. This lack of information in combination with obstacles preventing 256:. Treatment is typically by surgery. If treated early, the use of a 5562: 5268: 4609: 4426: 4340: 4318: 4238: 4139: 4047: 3954: 3881: 3799: 3619: 2863:

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fistulae are almost entirely preventable with appropriate use of

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Champagne BJ, McGee MF (February 2010). "Rectovaginal fistula".

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In sub-Saharan Africa, many girls enter into arranged marriages

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Hole that develops in the birth canal as a result of childbirth

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is important to prevent fistulae in subsequent pregnancies.

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Management of Common Problems in Obstetrics and Gynecology

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Obstetric fistulae can also be caused by poorly performed

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International Conference on Population and Development

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can help the patient, but not necessarily cure them.

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Irritation or pain in the vagina or surrounding areas

264:

may also be useful. An estimated 2 million people in

3467: 1614: 1192:"Vaginal Fistula Causes, Symptoms, & Treatments" 356:. Ulceration and infections can persist, as well as 3396:

Engender Health: Improving Women's Health Worldwide

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