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what is fistula?
fast facts & FAQs
fistula links
one woman's story
doctor's corner
Obstetric fistula is the most devastating of all pregnancy-related disabilities.
~UNFPA
Obstetric fistula is the most dramatic aftermath of neglected childbirth.
~WHO
Vesico-vaginal fistula is a debilitating, humiliating, and life-threatening result of obstructed labor.
~AMDD
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Fast Facts
- Fistula used to be present in the U.S. and Europe,
but was largely eliminated in the latter part of the
19th century and early 20th century with improved obstetric
care in general and the use of c-sections in particular
to relieve obstructed labor.
- The World Health Organization estimates that approximately
2 million women have untreated fistula and that approximately
100,000 women develop fistula each year. Fistula
is most prevalent in sub-Saharan Africa and Asia.
- In Ethiopia, alone, there are an estimated 100,000
women suffering with untreated fistula, and another 9,000
women who develop fistula each year.
- Less than 6 in 10 women in developing countries give
birth with any trained professional, such as a midwife
or a doctor. In Ethiopia, only 1 in 10 women
have a trained attendant. When complications arise,
as they do in approximately 15% of all births, there
is no one available to treat the woman, leading to disabling
injuries like fistula, and even death.
- The root causes of fistula are grinding poverty and
the low status of women and girls. In Ethiopia,
the poverty and malnutrition in children contributes
to the condition of stunting, where the girl skeleton,
and therefore pelvis as well, do not fully mature. This
stunted condition can contribute to obstructed labor,
and therefore fistula.
- But, fistula is both preventable and treatable. The
Addis Ababa Fistula Hospital has treated over 30,000
women over 33 years. Their cure rate is over
90%. Fistula can be prevented if laboring
women are provided with adequate emergency obstetric
care when complications arise.
Frequently Asked Questions (FAQs)
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| Q: |
What is an
obstetric fistula? |
| A: |
A fistula is a hole. An
obstetric fistula of the kind that occurs in Ethiopia
(and many other developing countries) is a hole
between a woman's birth passage and one or more
of her internal organs. This hole develops over
many days of obstructed labor, when the pressure
of the baby's head against the mother's pelvis cuts
off blood supply to delicate tissues in the region.
The dead tissue falls away and the woman is left
with a hole between her vagina and her bladder (called
a vesicovaginal fistula or VVF) and sometimes between
her vagina and rectum (rectovaginal fistula, RVF).
This hole results in permanent incontinence of urine
and/or feces. A majority of women who develop fistulas
are abandoned by their husbands and ostracized by
their communities because of their inability to
have children and their foul smell. |
| Q: |
Can fistula be "cured"? |
| A: |
Yes. An obstetric fistula can be closed with intravaginal surgery. If her surgery is performed by a skilled surgeon, a fistula patient has a good chance of returning to a normal life with full control of her bodily functions. The Fistula Hospital has a 93% success/cure rate. |
| Q: |
How much does it cost to treat a fistula? |
| A: |
At the Hamlin Fistula Hospitals, it costs US$450
to provide one woman with a fistula repair operation,
high-quality postoperative care, a new dress, and
bus fare home. |
| Q: |
What are the causes of
obstetric fistula? |
| A: |
A fistula results from an obstructed
labor that is left unrelieved and untreated. It
is estimated that 5% of all pregnant women worldwide
will experience obstructed labor. In the United
States and other affluent countries, emergency obstetric
care is readily available. In many developing countries
where there are few hospitals, few doctors, and
poor transportation systems, and where women are
not highly valued, obstructed labor often results
in death of the mother. When she survives, there
is a great likelihood her child will die and she
will develop a fistula. According to the United
Nations Population Fund (UNFPA), there are three
delays that contribute to the development of a fistula:
delay in seeking medical attention; delay in reaching
a medical facility; and delay in receiving medical
care once arriving at a health care facility. |
| Q: |
I heard that fistulas
are a result of female genital mutilation. Is this true? |
| A: |
While harmful traditional practices
such as female genital mutilation (FGM) are rightly
of concern to the international medical community,
they are not major contributors to the development
of an obstetric fistula. Some patients at the Hamlin
Fistula Hospitals have been victims of FGM, but
their fistulas are almost always caused by an obstructed
labor resulting from a too-small pelvis or a malpresentation
of the baby. FGM does not "cause" a fistula.
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| Q: |
How many women does this problem affect? |
| A: |
Because fistula affects women
in the most remote regions of the world, an accurate
count is very hard to achieve. The most common
estimate is that 100,000 women worldwide develop
fistulas every year, though some estimates put
the number closer to 500,000. Experts at the Hamlin
Fistula Hospitals estimate that there are approximately
9,000 new cases of fistula every year in Ethiopia
alone. Because most fistula sufferers are young
women—many still in their teens—they are likely
to live with their condition for upwards of 25 years.
By any estimate, there are at least two million
women currently living with fistula throughout the
developing world. The world capacity to treat fistula
is estimated at 6,500 fistula repair surgeries per
year. |
| Q: |
Where is fistula prevalent? |
| A: |
There is a high incidence of fistula
in Africa and parts of Asia, but women are susceptible
to developing fistulas wherever there are insufficient
emergency obstetric care systems. |
| Q: |
Can fistula be prevented? |
| A: |
Any woman who can gain access
to emergency obstetric care such as a cesarean
section will not develop a fistula. This is why
Hamlin Fistula Hospitals are building new small
hospitals in five Ethiopian provinces to increase
the capacity of regional hospitals to provide fistula
repair surgery and quality emergency obstetric
care. |
| Q: |
What can I do to help? |
| A: |
A tax-deductible donation
to the Fistula Foundation directly assists in restoring
health and dignity to women in Ethiopia suffering
from fistulas.
The Fistula Foundation is also expanding its Circle
of Friends, a program which assists groups
and individuals who want to hold their own fundraisers
to support the Hamlin Fistula Hospitals. If you
have questions about any of our programs, feel
free to email us at info@fistulafoundation.org. |
For answers to frequently asked questions about making a charitable contribution to help fight fistula, visit our FAQ About Giving page.
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