Obstetric fistula, impact on women

Reuters on Friday examined obstetric fistula and its impact on women living with the condition (Ringler, Reuters, 3/30). Obstetric fistulas develop when a fetus becomes lodged during labor in the narrow birth canal of a girl or young woman, causing pressure that blocks the flow of blood to vital tissues and tearing holes in the bowel, urethra or both, causing incontinence.

Physicians can repair a small fistula surgically in less than two hours, but repairing a larger fistula and restoring a woman's continence sometimes requires more than one surgery (Kaiser Daily Women's Health Policy Report, 2/22).

According to Reuters, about two million women in developing countries have fistulas, and the condition is prevalent among malnourished women. About 200,000 women in Ethiopia have the condition, and the country records about 9,000 new cases annually.

Andrew Browning, an Australian gynecologist who has been working at a fistula clinic in Ethiopia for two years, said that women with the condition "live a life of poverty and misery" and are "outcast[s] for the rest of their lives."

The operation to repair obstetric fistula is successful in more than 97% of cases, but the $300 cost is too expensive for most women in Ethiopia.

Browning's clinic and the Addis Ababa Fistula Hospital rely on donations to perform the operations (Reuters, 3/30).

In addition, the U.N. Population Fund in 2003 launched "End Fistula," a worldwide campaign that is working in 35 countries in Africa, Asia and the Middle East to eradicate fistulas by 2015.

The campaign received $4.9 million from donors in 2005, and last year it asked for $78.3 million in funding over five years (Kaiser Daily Women's Health Policy Report, 2/22).

Browning said he is concerned that fistula does not have the "donor appeal" of illnesses such as HIV/AIDS or malaria, which attract donations from charities and Western philanthropists.

"There's estimated to be about two million patients waiting, predominantly in Africa, for treatment, and currently the world's capacity in dealing with the problem is about 8,000 to 10,000 cases being done every year," Browning said, adding, "We are really touching the tip of the iceberg" (Reuters, 3/30).