Obstetric fistula: Guiding principles for clinical management and programme development

Sep 1 2006

The World Health Organization (WHO) Goodwill Ambassador for Maternal, Newborn and Child Health and supermodel Liya Kebede has highlighted the plight of millions of women and girls living with obstetric fistula.

Speaking at the launch of the WHO manual: Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development, Ms Kebede said the most marginalized and impoverished groups of women and girls are most affected by the condition because of complications during pregnancy. Adolescent girls are particularly susceptible because their pelvises are not fully developed. The fistula, or tear, happens during an obstructed labour when the tissue between a woman's vagina and bladder and/or rectum is torn. This results in the continuous leaking of urine or faeces.

The event, which marks a major milestone in the fight against obstetric fistula, brought together medical experts and heads of government to launch the first manual intended as a practical guide for use by health-care professionals and planners, policy-makers and community leaders. It is expected to be widely used in countries to implement effective programmes to dramatically reduce the number of women developing obstetric fistula.

More than a half a million healthy young women die from complications of pregnancy and childbirth including obstetric fistula each year. WHO estimates that globally, over 300 million women currently suffer from short or long term complications, with 20 million new cases each year. Obstetric fistula accounts for 8 percent of maternal deaths world wide with millions more women and girls living with shame, isolation and abject poverty because of the stigma linked to their condition.

Most women who develop untreated fistula have given birth at home with no assistance from a skilled birth attendant. In Nigeria, it is estimated that 1 in 10 women will suffer from the condition following childbirth. In addition, because of obstetric fistula women and girls are often abandoned by their husbands and excluded by families and communities. In India and Pakistan, some 70% of women with fistula have been abandoned or divorced.

"Obstetric fistula has been relatively neglected despite the devastating impact it has on the lives of girls and women in developing courtiers," says Liya Kebede. "I am thrilled and honored to be back in my native country to take part in the launch of the Obstetric Fistula Manual. It is my hope that these guiding principles will help women currently affected by fistula in Ethiopia, and prevent future incidents from happening in developing countries around the globe by making sure that every woman has access to skilled care during pregnancy and child birth."

Many of the cases of fistula can be largely avoided by delaying the age of first pregnancy, by stopping harmful traditional practices and by timely access to obstetric care Also, most girls and young women could be cured by simple surgery. But due to a lack of hospitals and health facilities or surgeons who offer fistula repair services, these women carry on suffering from the physical, psychological and social impact of the condition.

"No woman should have to endure a condition which is both preventable and treatable. Our long term goal should be to make fistula as rare in the developing world as it is in developed countries," says Joy Phumaphi, Assistant Director- General for Family and Community Health at WHO. "Thankfully, fistula has recently begun to gain international attention. Today everyone working in reproductive and maternal health has a chance to restore hope and dignity to millions of women and girls."

In partnership with UNFPA, the Campaign to End Fistula, Averting Maternal Death and Disability and the International Federation of Gynecology and Obstetrics, WHO has scaled up efforts and developed a multi-tiered prevention strategy to tackle fistula. This includes health promotion and family planning, access to skilled care during pregnancy and childbirth, provision of facilities for fistula repair and training health-care workers in the prevention, management and repair of fistula as outlined in the manual to tackle the condition from its early stages. The strategy engages the community, family members, health workers, and the larger society in risk assessment and knowledge of rapid response in order to effectively provide treatment and prevention services for fistula.

For more information contact:

In Addis Ababa, Tala Dowlatshahi,
Telephone: +41 79 4 49 57 84

In Geneva, Christopher Powell
Communications Adviser
Family and Community Health
WHO/Geneva
Telephone: +41 22 7 91 28 88
Mobile: +41 79 2 17 34 25
E-mail: [email protected]