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UN Population Fund Draws Attention to Obstetric Fistula in African Women - 2003-06-18


The United Nations Population Fund Wednesday unveiled a report on a deadly disease called obstetric fistula that strikes pregnant women. The survey finds the disease prevalent in sub-Saharan Africa, a region already beset by AIDS, malaria, famine, poverty, and political instability. Obstetric fistula is a pregnancy-related disability caused by prolonged, obstructed labor. Without medical attention, the baby usually dies at birth, and the woman is left leaking urine and/or feces.

Dr. Amy Pollock of Engender Health, the organization commissioned by the United Nations to conduct the survey, says some women die from infection or blood loss caused by the obstructed labor, and those who manage to live with it do not receive adequate care, and are frequently shunned by friends and family because the prolonged labor is often believed to be the result of a curse, or adultery.

"Women are totally stigmatized as a result of this problem, as a result of malodor due to leaking of urine or feces," she said. "They are rejected by the families often, by their spouses, almost always. They live an isolated life. For that reason, women are willing to walk - and we heard stories about this across the board in all countries - for days, for weeks. They are willing to wait at the site where they think a surgeon will return. For days, for weeks, for months, in one case years. They camp near the site hoping desperately."

The study focuses on nine countries: Benin, Chad, Malawi, Mali, Mozambique, Niger, Nigeria, Uganda and Zambia. Dr. Pollock says doctors there are unable to meet the demand for care. She cites one incident in Uganda, where a visiting doctor could only operate on 22 of the 200 women who had come for treatment before he had to leave.

The report estimates the number of women living with fistula in sub-Saharan Africa at two million. But Dr. France Donnay of the U.N. Population Fund says the figure is probably a "gross underestimation."

"These are only the women who are presenting themselves for treatment at the hospital," she said. "We know that many women never come to the hospital, They are unaware that treatment is available, so they stay in their villages, in separate houses in villages. In Nigeria alone, we learned that there could be as many as one million women with fistula."

According to the report, women living with fistula are usually under 20, illiterate and poor.

The researchers say they hope the report will raise a "global alarm" and encourage the international community to help fix the problem.

Fistula is both preventable and treatable and is virtually unheard of in the developed world. In the 19th century, there was a hospital in New York City devoted exclusively to fistula treatment. It closed 100 years ago when cases of fistula petered out. It is now the Waldorf Astoria Hotel.

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