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Explainer: What causes obstetric fistula
An obstetric fistula is an abnormal opening between the vagina and the bladder of rectum leading to continuous urinary or faecal incontinence.
What you need to know:
- Dr Mabeya says 95 per cent of fistula cases are caused by obstructed labour, which also normally sees 70 per cent of the babies die in the process.
- He also lists other causes of fistula to caesarean section surgeries where patients are accidentally injured, cancers and sexual assaults, complications from pelvic surgery and infection among others.
A large number of women in Kenya are increasingly being diagnosed with obstetric fistula, a condition that has made those affected live in shame and stigma. A significant number of women who suffer from the condition are unaware of what it is and whether it can be cured.
The lack of awareness and understanding surrounding fistula is a major barrier to seeking treatment. Women affected by this condition may not realise that their symptoms are caused by a treatable medical issue. They may mistakenly believe that their condition is untreatable or a normal consequence of childbirth.
Available data shows that about 24,000 women and girls are currently suffering from fistula, with an additional 3,000 contracting the disease annually.
So, what are the causes of fistula, and what remedies exist for women living with this condition? According to Dr Hillary Mabeya, a renowned obstetric fistula surgeon, obstructed labour without timely medical treatment is one of the leading causes.
Dr Mabeya says 95 per cent of fistula cases result from obstructed labour, which also normally leads to 70 percent of babies dying during the process.
Other causes include complications from caesarean section surgeries, cancers, sexual assaults, pelvic surgery complications, and infections, among others. Signs of obstetric fistula include uncontrolled leakage of urine and stool.
Dr Mabeya cites stigma as the biggest challenge, preventing women with fistula from seeking help.
"Poverty and lack of information on the condition are also major setbacks. We have few hospitals where fistula screening and treatment are done," he tells Nation.Africa.
He calls for early and regular screening to detect and treat the condition promptly. Obstetric fistula is preventable; it can largely be avoided by delaying the age of first pregnancy, ending harmful traditional practices, and ensuring timely access to obstetric care.
The United Nations Population Fund (UNFPA) country director, Anders Thomsen, says the condition is preventable and that advocacy is needed. He urges women living with fistula to seek help and advocates for preventive care through timely referrals to hospitals and ensuring expectant mothers deliver with professional birth attendants.
"UNFPA is committed to helping women living with fistula put a smile on their face by providing funding for fistula eradication campaigns. We will continue to support through funding, technical assistance, and fighting stigma, as stigma has been the undoing," Thomsen says.
Dr Karen Aura, the fistula lead at the Reproductive and Maternal Health Division at the Ministry of Health, notes an urgent need to enhance healthcare capacity through more training for doctors and nurses in handling fistula.
"We have developed a training package for surgeons in fistula treatment to build their capacity. Our target is to have fistula care centres across all 47 counties by 2030," she adds.
The World Health Organisation estimates that more than two million women live with fistula worldwide, with 50,000 to 100,000 new cases occurring each year.
In Kenya, an estimated 3,000 new fistula cases are recorded annually, but only 7.5 percent of women can access medical care. This means every year, more than 2,700 women with new fistula cases do not receive the necessary medical care.
