The silent reality of obstetric fistula
January 17, 2025
Commentary by Associate Professor Dr Khine Pwint Phyu,
Associate Professor Dr Ganesh Ramachandran, and Associate Professor Dr Anitha Ponnupillai - academics specialized in Obstetrics & Gynecology, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University. Obstetric fistula, an excruciating childbirth injury resulting in an abnormal connection between a woman’s birth canal and bladder or rectum, continues to haunt countless lives. Despite its profound impact, obstetric fistula remains largely unspoken, hidden in the shadows of societal taboos and healthcare disparities.
Within the Southeast Asian region, including Malaysia, reliable data remains elusive, making it challenging to ascertain the true prevalence of this condition. However, empirically, because of the access most women in the country have to good healthcare facilities, obstetric fistulas are exceedingly uncommon in our country. Globally, 65 percent of obstetric fistula cases occur in girls under the age of 18. It is a devastating childbirth injury afflicting the most impoverished and vulnerable girls and women. The physical, emotional, psychological, social, and economic consequences incurred by experiencing this condition at a younger age change their life forever and often face abandonment and ostracization by the family, friends, and society. The cause of obstetric fistulas lies in traumatic childbirth experiences. Prolonged and difficult labours subject women to prolonged pressure on the birth canal, resulting in inflammation, tissue damage, and death of cells. This can lead to the formation of fistulas, creating distressing symptoms such as urinary or faecal leakage, foul-smelling vaginal discharge, and chronic vaginal infections or painful sexual intercourse. This injury results in extreme physical taboo and even isolation of the individual, which in turn results in emotional and mental burdens causing low self-esteem and depression. The long-term impact on intimate relations between a husband and wife exacerbate both physical and mental wellbeing of the woman too. Contributing factors that heighten the risk of obstetric fistula: 1.Limited access to skilled healthcare Inadequate access to skilled birth attendants and emergency obstetric care are main determinants of obstetric fistulas. Prolonged labor without proper medical intervention can lead to severe birth trauma and fistula formation. 2.Socioeconomic challenges Poverty and lack of education initiate the burden of maternal health complications. Vulnerable populations are young women in underprivileged environments who may be subjected to childhood marriages, teenage pregnancies, and its complications which include fistula formation. 3.Social stigma and cultural barriers Some cultural beliefs and societal stigma surrounding childbirth-related injuries impede timely medical interventions. Misconceptions and shame prevent women from seeking the necessary healthcare, thus exacerbating the severity of obstetric fistulas. 4.Limited access to treatment Limited trained healthcare professionals and resources for fistula repair poses a formidable obstacle to timely treatment. Inadequate healthcare infrastructure and surgical facilities prolong the suffering of affected women. To minimize the incidence of obstetric fistulas, the following initiatives must be taken: 1.Promoting access to quality maternal healthcare Strengthening maternal healthcare services, especially in remote areas, is crucial. Ensuring healthcare for all, accessible care during pregnancy, labor and after childbirth play a major role in minimizing obstetric fistula and other birth-related complications including death due to childbirth and its complications. 2.Health education initiatives Public awareness campaigns and access to education are instrumental in dispelling myths and fostering early recognition of birth injuries. Empowering women with knowledge about childbirth complications encourages proactive seeking of medical assistance and reduces the stigma surrounding fistulas. 3.Enhancing healthcare infrastructure Investing in healthcare infrastructure, including skilled birth attendants, surgical facilities, and postoperative rehabilitation services, play a crucial role. Adequate resources and training for healthcare professionals assist in ensuring timely diagnosis, treatment, and rehabilitation of obstetric fistula patients. 4.Population studies and research Conducting comprehensive population studies on the prevalence and incidence of obstetric fistula is essential for establishing accurate regional data. By identifying causative factors, such research not only sheds light on the root causes but also helps in curtailing and eliminating the culprits responsible for obstetric fistulas. In Malaysia, extensive measures are taken to ensure that both urban and rural areas receive adequate care during pregnancy, labour, and childbirth. Intensive training programs for midwives are conducted to ensure the delivery of babies with safe techniques and the timely diagnosis of serious postpartum complications, including obstetric fistulas. Furthermore, urogynaecology departments have been established in both private and public sectors, staffed with trained urogynaecologists to effectively treat obstetric fistulas efficiently if at all they occur and provide comprehensive rehabilitation services. It is essential that we break the silence and advocate for the rights and dignity of women affected by this condition. Through collective action and consistent commitment, we can minimize the debilitating complications of obstetric fistula, paving the way towards a future where every woman is ensured the right to safe and high-quality emergency obstetric care during childbirth. |
EXPLORE FURTHER
|
20 Clever ways for busy moms to sneak in some 'me time' every dayPrioritize self-care, as taking care of oneself can actually make it easier to take care of others
|
|
5 Ways to tweak your health and diet for a healthier decadeThe age milestone is a good reminder
|
|
Surviving, living or striving as a woman: Overcoming poverty and hardshipUnleash your potential as a woman
|
|
Breaking societal norms: Women's ambition after marriage and childrenIs it wrong?
|
|
Perimenopause and menopause: Knowing what to expectHot flashes and disturbed sleep are common hallmarks
|
|
(Ask a Dr) I fart when I orgasm. Is there anything I can do to make it stop?Pre-lovemaking no-nos: Foods to avoid
|
|
Women's sexuality and pleasure: What are we so afraid of?From nervous twinges to empowered pleasure
|
|
Stretching and strengthening exercises for a frozen shoulderThe inflammatory phase to freezing stage
|
|
Giving birth can trigger autoimmune thyroid diseaseUnderstanding hypothyroidism: Causes and connections to iodine deficiency
|
|
Pelvic floor dysfunction: Effects on urination, bowel movements, and sexual intercourseA comprehensive guide
|
|
Pelvic organ prolapse explainedNumbness during sex a possible symptom
|
|
Understanding pelvic pain: Causes, symptoms, and treatmentExploring the complexities and effective management options
|
|
No period, yet not pregnant? Here is a possible reasonUnderstanding primary ovarian insufficiency (POI) and its impact on women's health
|
|
Carpal tunnel syndrome more common in women than menAssociation of diabetes, gout, and rheumatoid arthritis
|
|
Magnesium deficiency causes sweet craving and stress eatingFactors affecting magnesium intake
|
|
The difference between premature ovarian failure and premature menopauseThe connection between conception and infertility
|
