What is obstetric fistula?

Obstetric fistula is an opening or hole, between the vagina and rectum or bladder, leaving a woman incontinent.

What are the causes?

Obstetric fistula is caused by prolonged and obstructed labour.

What are the symptoms?

If untreated, a woman with obstetric fistula will experience constant and uncontrollable leakage of urine or feces.

What does that mean to women in society?

In addition to physical injuries, many women with fistula suffer humiliation, isolation and stigma as a result of the smell and constant leakage. And in most cases of obstructed labour in which a fistula develops, the baby is stillborn.

How is Rwanda supporting women with obstetric fistula?

 

A study at the Teaching Hospital of Kigali (CHUK) from 1997 – 2001 found that, of 112 women operated for fistula, 98% of their fistulas were of obstetric origin (i.e. associated with childbirth).

"On average, most of the women had been in labour for 29 hours."

The average age of fistula patients was 25 years. For 72% of these women, this was the first time they had been pregnant. More than half sought surgical repair after 12 months of living with the condition, though some had waited for years unaware that anything could be done for them.

Eleven hospitals have been selected to provide fistula services, based on the Minister of Health’s desire to have these treatments geographically accessible from all parts of the country.

 

Photo credit: IOWD

 

What is the situation like today compared to ten years ago?

 

Since 2006, the Government of Rwanda has provided fistula repair operations in close collaboration with USAID, United Nations Population Fund (UNFPA), International Organization for Women and Development (IOWD), GIZ, Swiss Embassy and other development partners.

"The Minister of Health wants treatments geographically accessible from all parts of the country."

The obstetric fistula prevention and repair missions, organised by the Ministry of Health, started in 2010 at Kibagabaga, Ruhengeri, CHUK, Rwanda Military Hospital (RMH), Kibogora and Mugonero Hospitals. At that time the average number of cases received was 75 per mission, then, based on strong community mobilisation and partnership with district hospitals, the number has increased to 250 per mission. These missions are run at least three times a year.

Since 2016, fistula care support through development partners aims to support the Ministry of Health in addressing the increasing demand for fistula care by providing treatment and/or prevention services. On proposition of the Ministry of Health, Ruhengeri hospital (in the North) and Kibungo hospital (in the East) will be supported to integrate routine fistula care, seeing them become fistula model sites.

 

Do cultural practices and traditional beliefs have an influence?

 

Obstetric fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty in this geographic region plays an important role in perpetuating obstetric fistula, sociocultural practices have a significant influence on susceptibility to the condition: early marriages and early child bearing; unskilled birth attendance and sociocultural limitations to modern healthcare access for women during childbirth.

"We need to empower women to defy oppressive traditions and enable them to improve their social status."

It is vital to boost the power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. Imperatively, the practice of traditional healing must be regulated and the primary health care services must be strengthened for women.

In Rwanda, the legal age of marriage is 21 years and government policy demands that mothers give birth at health facilities, abolishing the traditional birth attendance. As a result, 91% of babies are now delivered at health facilities.

 

Photo credit: IOWD

 

Do all women with obstetric fistula face stigma and discrimination?

 

Millions of girls and young women in resource-poor countries are living with fistula in shame and isolation, often abandoned by their husbands and excluded by their families and communities. They usually live in poverty, shunned or blamed by society and unable to earn money – many fall deeper into poverty and further despair.

"Women and girls are abandoned by their husbands and excluded by families and communities."

There is a general lack of knowledge about fistula repair services at community level, but a major reason patients delay seeking repair is that the majority of health facilities are still challenged by insufficient skilled manpower, infrastructure, equipment and support to handle prevention, repair and social reintegration of fistula patients.

In Rwanda, by organising several campaigns (for prevention and treatment of fistula), we managed to increase awareness of fistula among the general population, decreasing the stigma against women with fistula. This has led to an increased number of women seeking treatment.