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Table of Contents   
EDITORIAL COMMENTARY  
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 797-798
Responding to the public health challenge of obstetric fistula in developing nations: A preventable cause of physical and social disability


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

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Date of Web Publication5-Oct-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Responding to the public health challenge of obstetric fistula in developing nations: A preventable cause of physical and social disability. Ann Trop Med Public Health 2017;10:797-8

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Responding to the public health challenge of obstetric fistula in developing nations: A preventable cause of physical and social disability. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 16];10:797-8. Available from: http://www.atmph.org/text.asp?2017/10/4/797/196515
Prolonged obstructed labor is a frequent incident in areas with no or limited access to emergency obstetric care.[1] Women who survive the episode of prolonged obstructed labor often develop an obstetric fistula (OF), which has been acknowledged as one of the most severe and disastrous maternal morbidities.[2] In fact, the current estimates suggest that almost 0.1 million girls and women develop an OF each year, with incidence being extremely high in developing nations.[1],[2] In addition, the incidence is extremely common among young girls with underdeveloped pelvic bony structures, who become pregnant and are exposed to the potential risk of childbirth trauma.[3]

OF is a birth injury occurring due to the pressure exerted by the fetal body parts against the birth canal tissues, bladder base, urethra, or sometimes rectum, resulting in the development of a fistula either between the vagina and bladder (more common) or between the vagina and rectum.[1],[2],[3] Thus, the affected women leak urine and/or feces out of the vagina constantly without control, which results in the abandonment and exclusion of the women from the family and the society.[1] In other words, OF accounts for both physical and social disabilities among the women and significantly affects the quality of life and well-being of women socially, economically, and psychologically.[1],[4]

It is important to understand that there is a strong correlation between the development of an OF and the birth of a still-born child.[3] In addition, in the absence of an immediate correction, OF has been linked with consequences like secondary infertility, chronic skin irritation, discrimination, desertion, loss of support from the community, marital disharmony (divorce or separation), depression, reduction in financial productivity and worsening of poverty, poor nutrition, reduced self-esteem, and even premature deaths.[2],[3],[4] Furthermore, owing to the stigma associated with the condition in the community, there is no guarantee that the defect women will be accepted by their family even after the repair.[4]

Acknowledging the magnitude of the problem, a special campaign was initiated in 2003 to end fistula by the UN Population Fund and other stakeholders.[5] Although this campaign played a crucial role in increasing the level of awareness among the policy makers, not much was accomplished in the field of global fistula eradication.[4],[5] As developed nations achieved the target of fistula elimination almost a century ago, it is quite alarming in case of developing nations and reflects the ineffectiveness of the health sector in reaching all women to ensure provision of skilled birth care.[2],[3],[4] In order to improve the existing scenario, it is extremely vital to obtain a precise estimate about the magnitude of the problem, expand the access to surgical care, implement measures for the social rehabilitation and acceptance of the patients by their families through community sensitization campaigns, and ensure integration of fistula prevention with national maternal and newborn health plan.[1],[2],[4]

Further, specific measures should be directed toward the predisposing factors like home delivery, absence of skilled birth attendants or emergency obstetric care facilities, poor monitoring of labor progression, etc., to significantly reduce the incidence of OF.[1],[2],[5] In addition, women should be motivated to avail surgical care and measures should be predominantly targeted toward most marginalized and vulnerable women, and better counseling and linkage with women should be maintained postsurgery to improve their follow-up and hence achieve their reintegration in the society.[5],[6]

To conclude, the problem of OF continues to be prevalent in the low-resource settings despite being preventable and treatable. It is high time that skilled birth care is extended to all women to minimize its incidence and expand surgical care to ensure acceptance of the women in their communities.

Acknowledgement

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mselle LT, Kohi TW. Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania. BMC Womens Health 2015;15:107.  Back to cited text no. 1
[PUBMED]    
2.
Cowgill KD, Bishop J, Norgaard AK, Rubens CE, Gravett MG. Obstetric fistula in low-resource countries: an under-valued and under-studied problem-systematic review of its incidence, prevalence, and association with stillbirth. BMC Pregnancy Childbirth 2015;15:193.  Back to cited text no. 2
    
3.
Ahmed S, Anastasi E, Laski L. Double burden of tragedy: stillbirth and obstetric fistula. Lancet Glob Health 2016;4:e80-e82.  Back to cited text no. 3
[PUBMED]    
4.
Drew LB, Wilkinson JP, Nundwe W, Moyo M, Mataya R, Mwale M. Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC Pregnancy Childbirth 2016;16:2.  Back to cited text no. 4
    
5.
UNFPAAfter childbirth trauma, Afghan women emerge from life in shadows; 2016. Available from: http://www.unfpa.org/news/after-childbirth-trauma-afghan-women-emerge-life-shadows. [Last accessed on 2016 July 4].  Back to cited text no. 5
    
6.
Delamou A, Delvaux T, Utz B, Camara BS, Beavogui AH, Cole B. Factors associated with loss to follow-up in women undergoing repair for obstetric fistula in Guinea. Trop Med Int Health 2015;20:1454-61.  Back to cited text no. 6
    

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Correspondence Address:
Saurabh R Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196515

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