Thursday, December 9, 2010

Obstetric Fistula

Obstetric fistula is virtually unknown in developed nations. Women in chad are among those with an elevated risk of obstetric fistula. In 2003, the unfpa started what it called its campaign to end fistula.

In the majority of cases of obstetric fistula, the baby is stillborn. In addition to the mother, dealing with the loss of her baby, she is left with physical pain as well as social and emotional trauma from living with chronic urinary incontinence (the unintentional loss of urine. The inability to hold urine in the bladder due to loss of voluntary control over the urinary sphincters resulting in the involuntary passage of urine. The social consequences for girls and women living with obstetric fistula include isolation, divorce or abandonment, ridicule and shame, inability to start a family, illness, risk of violence, and lack of opportunity. Left without support, the women are often forced to beg or turn to prostitution to survive. The medical consequences for girls and women living with obstetric fistula are incontinence, but also frequent bladder infections, infertility, and foul odor.

Obstetric fistula is at risk for other urologic diseases such as renal failure, gynecologic sequelae such as vaginal stenosis and infertility, and neurologic disorders including foot drop. The most devastating consequence is the impact obstetric fistula can have on their psychosocial life. Effective programs that include family planning, prenatal care, safe labor and delivery, and postpartum care are needed to reduce obstetric fistula rates. Also needed are interventions that focus on improving access to maternal health care, emergency obstetric care, and increased rates of cesarean delivery when indicated.

Obstetric fistula is dead women—physically and psychologically,” said Gloria Esegbona, a British doctor of Nigerian descent who has treated women with the condition in Africa. “Their injuries render them little more than cripples and scar their souls. Ninety six per cent of these women lose their babies, she said.

Obstetric fistula is early and/or closely-spaced pregnancies and lack of access to emergency obstetric care. Despite the fact that improved obstetric care and the use of the cesarean section eradicated fistulas in western countries by the end of the 19th century, women in the developing world continue to be plagued by the condition because of a lack of obstetric care, lack of adequate health care infrastructure, and a dearth of trained personnel. A woman living in a rural area, without access to any emergency obstetric care, faces a greatly increased risk of obstetric fistula should a complication arises during child birth. Less than 60% of women in developing countries give birth with a trained professional. While fistula is the result of a medical complication of childbirth that arises in approximately 15% of all births, the root causes are poverty and the low status of women and girls that cause them to give birth at a young age, and, often, without medical attention.

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