Preventable Dilemma

Intro: Obstetric fistula is a condition that occurs during childbirth when a rupture 

or hole in the birth canal obstructs delivery of the infant. You! takes a look... 

Many of us aren't aware of this fact but each year at least 50000 to 100000 women worldwide are affected by obstetric fistula; a hole in the birth canal. The development of obstetric fistula is directly linked to obstructed labour and it is estimated that obstructed labour occurs in approximately 4.6 per cent of deliveries worldwide.
Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems and unfortunately most of them are deprived of a cure. A research shows that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa, causing their suffering to prolong. Read on to find out more about the medical problem.

What is it?
When the obstructed labour is unrelieved by medical intervention, the pressure of the baby's head against the woman's pelvis can cause extensive tissue damage. If a woman survives such a labour, she may be left with a fistula between her vagina and bladder and/or vagina and rectum, resulting in incontinence of urine. Women that experience an obstetric fistula have typically survived an average of three to four days of labour while others have been in labour for as long as a week.  In almost 90 per cent of cases, the baby that is born dies within the first week.
In addition to incontinence, the medical consequences of obstetric fistula include frequent bladder infections, painful genital ulcerations, kidney failure and infertility. The prolonged, obstructed labour may also cause a variety of health problems, such as stress incontinence, amenorrhea, pelvic inflammatory disease, secondary infertility, vaginal stenosis and foot-drop. The smell caused by the constant leaking of urine and faeces combined with misperceptions about the causes of birth complications often results in stigma and ostracism by communities and spousal abandonment.

Who is most vulnerable to it?
Eradicated in developed countries at the end of the 19th century when caesarean section became widely available, obstetric fistula still plagues women throughout the developing world, specifically in parts of Africa, India, Bangladesh, Afghanistan, Pakistan, and Nepal. It is estimated that there are 100,000 new cases each year, but the international capacity to treat obstetric fistula is limited to only 6,500 per year.

How is obstetric fistula treated?
Obstetric fistula is preventable and can be avoided by:
* Gaining access to doctors and proper medical facilities
* A surgical procedure in the case of a doctor being absent during childbirth
* Delaying the age of first pregnancy
* Timely access to obstetric care

Situation in Pakistan
An estimated 5,000 to 6,000 new cases of fistula are occurring in Pakistan every year. And one out of every three cases is Iatrogenic, meaning that it is caused by quacks, unskilled healthcare providers, surgeons and gynaecologists, who may be qualified, but are incompetent and thrive in the absence of an effective accountability mechanism. According to Prominent Gynaecologist Dr Sher Shah around 70 to 80 per cent of the deliveries in Pakistan are taking place in the rural areas under the supervision of 'dais' and unskilled attendants, who use archaic methods riddled with complications. "Fistula is more common among women in Dera Ghazi Khan, Swat, and Gilgit, among other areas," says Dr Sher Shah.

Prevention is better than cure...
Fistula can be best avoided by stopping early marriages, delaying the age of first pregnancy and by timely access to good emergency obstetric care. "Education is the key," says Dr Sher Shah. "Only education can get the Pakistani women out of this mire. There is no magic pill that we can give to our expectant mothers and no amount of programmes or projects will stop our women from dying unless our poor are educated." It's about time the government formulated a National Task Force for Fistula Treatment in order to transition from a campaign-based to a permanent approach for the management of this stark health challenge.