Kwalaulawa, Nigeria—Alone and in labor for more than 24 hours, Sahare Lawali suffered through the birth of her first child. The prolonged pressure of the baby’s head caused such damage that the 19-year-old was left with a hole, or “fistula,” between her vagina and bladder. Sahare’s baby didn’t survive and the tear left the bereft mother with a foul-smelling condition she was helpless to control.
“I am very sad and very much uncomfortable with my condition,” she said earlier this year.
An estimated two to three million women and girls suffer from obstetric fistula today, many of whom are shunned by relatives and neighbors because of the stench caused by leaking urine and feces. But obstetric fistula can be prevented with appropriate care and access to quality health care services—services that so many young and poor women living in rural areas of sub-Saharan Africa and Asia presently lack.
Fistula is caused by prolonged, obstructed labor, which can also cause vaginal tears, uterine rupture, genital prolapse and nerve damage causing a condition called drop foot. All of these conditions can be avoided when a woman delivers in the care of a skilled provider who is capable of performing emergency obstetric care, or, when not able to give this care, can refer the woman to the nearest health facility to get the care she needs and deserves.
At Jhpiego, we know that ending fistula is within our reach. We prepare health care providers to deliver evidence-based care to women early in their pregnancy through antenatal care. With education and training, doctors, midwives and nurses can strengthen their ability to provide essential obstetric and newborn care to support normal labor and birth, and comprehensive emergency care that includes cesarean section and other instrument-facilitated deliveries.
These frontline health workers learn to identify and treat obstructed labor—the cause of obstetric fistula and newborn death—and also provide information on healthy birth spacing and family planning services to reduce unwanted pregnancies and first births to women who are younger than 18.
Jhpiego has been using or promoting a number of low-cost interventions that help identify high-risk births and prepare providers to respond in an emergency by delivering appropriate care or referring the woman in labor to the nearest hospital where she can be treated. A continuum of care from home to hospital is essential in reducing deaths of mothers and newborns.
Sahare’s first pregnancy ended tragically for her and the baby. Her experience is typical of young, non-literate women in sub-Saharan Africa who marry and conceive before their bodies are fully mature. She was unaware of the importance of prenatal care and lived far from a health center.
Fortunately, Sahare managed to find the resources to visit the Gusau Fistula Rehabilitation Center, a full-day’s walk from her village. There, she spent nearly a month—first receiving the complicated surgical repair from a trained surgeon, then undergoing physical and emotional rehabilitation. Six weeks post-surgery she is still doing well. Hers is a positive outcome that is all too rare. With approximately 100,000 new cases of fistula each year, fistula repair sites like the Gusau Fistula Rehabilitation Center cannot keep up with the deluge of new cases.
That’s why prevention is so critical. Access to quality maternal health care, and knowledge among families of when to seek this care, should be priorities in every community, thereby preventing obstetric fistula from developing and causing unnecessary damage and despair.
And for the women who suffer from this condition now, there is additional hope. Jhpiego has recently developed a learning package on fistula repair and has joined with the United Nations Population Fund (UNFPA) in Nepal to begin sharing this knowledge and these skills with health care providers.
To learn more about Jhpiego’s work in maternal health, visit: Maternal, Newborn and Child Health.