Obstetric Fistula

Ending Obstetric Fistula, Together

The birth injury, which can have devastating consequences for women, was the focus of experts convening in Nepal last month

From the plenary stage in Kathmandu, Nepal, at the conference for the International Society of Obstetric Fistula Surgery (ISOFS), a speaker opened his talk with an old proverb.

“If you want to go fast, go alone,” he said. “If you want to go far, go together.”

This call for collaboration and mutual support reflected the spirit of the gathering of the world’s leading experts in obstetric fistula – a problem that no person, no matter their skill, can solve alone.

Lali, pictured here on the far right, received fistula repair surgery at Mid-Western Regional Hospital in Surkhet, Nepal. Lali had lived with the condition a decade before she was able to access surgical care. (Courtesy photo)
Lali, pictured here on the far right, received fistula repair surgery at Mid-Western Regional Hospital in Surkhet, Nepal. Lali had lived with the condition a decade before she was able to access surgical care. (Courtesy photo)

Obstetric fistula is an injury suffered by women during childbirth, typically when a woman undergoes a complex delivery without sufficient access to care from a skilled birth attendant. When a woman goes through prolonged obstructed labor, she may experience significant tears in her recto-vaginal tissues. The worst cases can result in the death of the baby and tissue necrosis, which in turn can develop into an extreme form of incontinence. If left untreated, obstetric fistula leads to social ostracism and long-term medical issues.

While a century ago obstetric fistula was prevalent worldwide, the condition has since become relatively unknown in areas with ready access to emergency obstetric surgery. The number of nations with current or new cases of obstetric fistula is down to roughly 55 countries, all of them located in the developing world. The fact that women are still afflicted by this condition anywhere when effective treatment is readily available is simply unacceptable. That was the theme of the recent ISOFS conference: “Hope, Healing and Dignity for All.”

Dr. Steve Arrowsmith and other experts on obstetric fistula gathered in Nepal last month as part of a conference sponsored by the International Society of Obstetric Fistula Surgeons. (Courtesy photo)
Dr. Steve Arrowsmith and other experts on obstetric fistula gathered in Nepal last month as part of a conference sponsored by the International Society of Obstetric Fistula Surgeons. (Courtesy photo)

This year’s conference was attended by over 300 delegates from dozens of countries – people working in the field of obstetric fistula repair and prevention, including fistula surgeons, advocates for health equality, public health professionals, and non-profit organizations – who joined together for a single purpose: to end obstetric fistula within a decade, in response to the UN’s call to action to stop the suffering of the estimated 2 million women worldwide that suffer from this condition.

A team from Direct Relief attended to present in several areas, including the Global Fistula Map, Direct Relief’s multi-year effort to locate and analyze the global distribution of obstetric fistula surgery, Direct Relief’s fistula modules; and on the use of telemedicine robots to the improvement of fistula care in Malawi.

The map above records surgical facilities around the world that provide obstetric fistula repair for women. Click to explore the map.
The map above documents surgical facilities around the world providing obstetric fistula repair for women. Click to explore the map.

The Global Fistula Map is one of the most widely used data resources in the global obstetric fistula repair community. The map uses data collected in an annual survey of health care providers to visualize all known fistula repair facilities worldwide. The collection and analysis of this data allow Direct Relief and many others to understand the landscape of the problem and to determine the size and scope of resources needed.

To meet the constant challenges of data collection, analysis and community engagement, Direct Relief is working to upgrade the Global Fistula Map through the creation of a new website with deeper contextual information, analytical tools, academic research, as well as ready access to open data on the causes, prevalence and consequences of obstetric fistula. The “End Obstetric Fistula” website will roll out later in 2019.

By mapping the problem and fostering collaboration, as the African proverb says, we can “go far” towards a better future for women throughout the world.

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