- - - OBSTETRIC FISTULA: ENDING THE HEALTH AND HUMAN RIGHTS TRAGEDY

Friday, 17th of May 2013

Volume 381, Issue 9879, Pages 1702 - 1703, 18 May 2013

Obstetric fistula: ending the health and human rights tragedy

Original Text

More than 2 million girls and women in developing countries are living with obstetric fistula, a condition that has been virtually eliminated in the industrialised world.1—3 Obstetric fistula results from prolonged obstructed labour in the absence of emergency medical interventions, notably caesarean section. The incontinence that ensues can lead to marginalisation and a range of psychological, social, economic, and physical vulnerabilities. Many women and girls with fistula find themselves trapped in poverty because they are excluded from community life, denied livelihood opportunities, and abandoned by their husbands and families.

Obstetric fistula is an outcome of the failure of health systems to provide accessible and equitable sexual and reproductive health services, including skilled birth attendance and referral to emergency obstetric care. It is, therefore, also the result of inadequate protection of the human rights of women and girls and it further entrenches socioeconomic and gender inequality. In some countries, child marriage and childbearing at a young age also contribute to the unacceptably high incidence of this condition, with an estimated 50 000 new cases annually.4

Major gaps exist in access to treatment. The Global Fistula Care Map, launched in 2012 by Direct Relief International, the United Nations Population Fund (UNFPA), and the Fistula Foundation, starkly demonstrates that only a fraction of patients with obstetric fistula receive treatment and that, tragically, the countries with the highest levels of maternal death and fistula have the highest unmet need for sexual and reproductive health services.

Taking the lead in global efforts to eliminate obstetric fistula, UNFPA and partners launched the Campaign to End Fistula in 2003. Through its prevention, treatment, and social reintegration strategies, the campaign is supporting women and girls worldwide to overcome this debilitating and stigmatising condition. The campaign embraces the power of partnerships to tackle fistula. With a presence in more than 50 countries, the Campaign to End Fistula unites more than 80 global organisations and many national and community-based ones to meet Millennium Development Goal (MDG) 5, to improve maternal health, and its target to ensure universal access to reproductive health.

Given recent progress in reducing maternal deaths5 and disabilities, a report of the UN Secretary-General, Supporting Efforts to End Obstetric Fistula, called for intensified political and financial mobilisation to accelerate progress towards ending obstetric fistula.6 Countries with the highest maternal mortality and morbidity, especially those struggling to make sufficient progress towards MDG 5,7 including South Sudan, Chad, Somalia, Central African Republic, and Sierra Leone, require special attention. In a 2012 resolution, the UN General Assembly cited the importance of reproductive rights and ending inequalities and child marriage in efforts to reduce obstetric fistula, and designated May 23 as the International Day to End Obstetric Fistula.

Harnessing the power and potential of mobile and e-technologies to empower and transform the lives of the poorest, most vulnerable, and marginalised populations is key to eliminating maternal mortality and morbidity, including obstetric fistula. One such initiative that is helping women and girls with obstetric fistula is Comprehensive Community-Based Rehabilitation In Tanzania (CCBRT). To help impoverished fistula patients access life-changing surgery, CCBRT uses the mobile banking system, M-PESA, to send money to community ambassadors who retrieve the funds from local M-PESA agents and buy bus fares for patients who need treatment. As a result, the number of patients seeking treatment for obstetric fistula at CCBRT has increased substantially.

Progress in reaching the MDGs has been insufficient among the poorest, most vulnerable, and marginalised groups worldwide.8 We must uphold and protect womens and girls human rights and achieve equity of access and outcomes to ensure these populations are reached.9 To end obstetric fistula and fully realise the rights of women and girls, we must address the structural drivers that perpetuate inequalities.10

Full-size image (19K) Corbis

I am Executive Director of UNFPA. I declare that I have no conflicts of interest.

References

1 WHO. 10 facts on obstetric fistula. http://www.who.int/features/factfiles/obstetric_fistula/en. (accessed April 26, 2013).

2 Stanton C, Holtz SA, Ahmed S. Challenges in measuring obstetric fistula. Int J Gynecol Obstet 2007; 99: S4-S9. PubMed

3 Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet 2006; 368: 1201-1209. Summary | Full Text | PDF(200KB) | CrossRef | PubMed

4 van BeekhuizenUnkels R, Mmuni NS, Kaiser M. Complications of obstructed labour: pressure necrosis of neonatal scalp and vesico-vaginal fistula. Lancet 2006; 368: 1210. Full Text | PDF(70KB) | CrossRef | PubMed

5 Lozano R, Wang H, Foreman KJ, et al. Progress towards MDGs 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011; 378: 1139-1165. Summary | Full Text | PDF(7166KB) | CrossRef | PubMed

6 UN. Supporting efforts to end obstetric fistula: report of the Secretary General. New York: United Nations, 2012.

7 WHO. Trends in maternal mortality: 1990 to 2010 WHO, UNICEF, UNFPA, and The World Bank estimates. Geneva: World Health Organization, 2012.

8 The Lancet. A manifesto for the world we want. Lancet 2012; 380: 1881. Full Text | PDF(98KB) | CrossRef | PubMed

9 UN. United Nations Secretary Generals Global Strategy for Womens and Childrens Health. http://www.everywomaneverychild.org. (accessed April 26, 2013).

10 Harland-Scott Cthe Advisory Group of the Global Thematic Consultation on Addressing Inequalities in the Post-2015 Development Agenda. Addressing inequalities: synthesis report of global public consultation. New York: UNICEF and UN Women, 2013.

a UN Population Fund, New York City, NY 10158, USA