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International Day to End Obstetric Fistulas

On this International Day to End Obstetric Fistula, we wanted to share with you the physical and mental toll that this condition takes on women who suffer from it. An obstetric fistula is the result of a prolonged and obstructed labour, which often happens in countries where pregnant women do not give birth in a medical setting or accompanied by a medical professional. It is a rupture between the birth canal and the bladder and/or the rectum. It leaves women with a lack of control over their bladders, which can lead to chronic medical problems, depression and social isolation.

Obstetric fistulas are preventable, mostly by delaying the age of first pregnancy. Timely access to medical care and the prevention of female genital mutilation/cutting are also effective in preventing obstetric fistulas. While CPAR is working with communities and healthcare centres in Ethiopia to address all these factors, we still need to care for the women who already have an obstetric fistula.

One of the biggest barriers that prevents women from seeking treatment for obstetric fistula is the inability to travel to get care. For most, hospitals and healthcare centres can be hours away, and taking public transit may not be possible due to the inability to control their bladders. CPAR is working with four hospitals – Hamlin Fistula Hospital, Fitche General Hospital, Assela Referral Hospital and the Gondar Specialized referral Hospital to develop a referral system for obstetric fistula cases. Drivers are being recruited and ambulances are being provided to facilitate the transport of patients comfortably and safely. Beds are also being provided to each hospital, so that they have the capacity to meet the needs of their patients. CPAR is making sure that the Zonal Health Authority and the Ethiopian Ministry of Health are informed about all developments so that they are involved and will be able to take over the referral system once it is up and running.

While making sure women suffering from obstetric fistulas get the physical care they need, their mental health is just as important. Interviews conducted with patients waiting for surgical repair at a fistula treatment centre found that women experienced a deep sense of loss, diminished self-worth and multiple social challenges due to obstetric fistula-related issues such as incontinence.[1] In Ethiopia specifically, women commonly report ostracization by their family and community members and feeling hopeless while isolated from the community.[2] Due to social stigma and pressure, women report that marriages do not survive due to the pressure of ongoing physical and emotional health issues caused by obstetric fistula.[3]

Counselling services and programs are desperately needed to address issues such as community discrimination, isolation, depression and psychological trauma. Engaging in rehabilitation and reintegration activities, including raising awareness in communities has been shown to have positive effects.[4] Studies have shown that Ethiopian women who receive treatment for fistulas report interest in participating in fistula-related advocacy initiatives, including raising awareness in their communities and supporting women with a fistula to get treatment.[5][6] By caring for women’s mental health and by providing counselling services, she can reintegrate society and feel comfortable in her body, her family and in her community.

If you would like to support our efforts to help end obstetric fistulas, you can do so here.
[1] D. T. Bashah, A. G. Worku, M. Yitayal, and T. Azale, “The Loss of Dignity: Social Experience and Coping of Women with Obstetric Fistula in Northwest Ethiopia,” BMC Women's Health, 19, no. 1 (2019): 1-10. 
[2] Misganaw Animut, Abebe Mamo, Lakew Abebe, Million Abera Berhe, Shifera Asfaw, and Zewdie Birhanu. “‘The Sun Keeps Rising but Darkness Surrounds Us’: A Qualitative Exploration of the Lived Experiences of Women with Obstetric Fistula in Ethiopia,” BMC Women's Health, 19 no. 37 (2019). 
[3] Bangser et al., 2011. 
[4] Shallon et al., 2018. 
[5] A. Shallon, O. A. Ojengbede, J. F. Mugisha, A. T. A. Odukogbe, “Social Reintegration and Rehabilitation of Obstetric Fistula Patients Before and After Repair in Sub-Saharan Africa: A Systematic Review,” Nepal Journal of Obstetrics and Gynaecology, 13, no. 2 (2018): 5-14. 
[6] K. Donnelly, E. Oliveras, Y. Tilahun, M. Belachew, and M. Asnake, “Quality of Life of Ethiopian Women After Fistula Repair: Implications on Rehabilitation and Social Reintegration Policy and Programming,” Culture, Health and Sexuality, 17, no. 2 (2015): 150-64.