Hilde Vautmans :
Obstetric fistula. If you’ve never heard of it, it’s likely that you’re living in a country in the industrialised world, where the condition is a thing of the past. However, for many of the world’s most marginalised women and girls, the devastation of fistula is something with which they are all too familiar. In 2015, the EU can play a major role in ending this severely neglected health and human rights tragedy.
From my field visits to developing countries in Africa, I have seen that poor women are the ones in these societies to suffer most. Nowhere is this more evident than in statistics showing high rates of maternal mortality and injury. Every day, almost 800 women die from pregnancy-related complications, the vast majority of them in poor countries. For every woman who dies, 20 or more are injured or disabled.
Medical & social consequences
One of the most serious injuries of childbearing is obstetric fistula, a hole in the birth canal, caused by prolonged, obstructed labour due to lack of timely and adequate medical care. Women living with fistula experience chronic incontinence (the leakage of bodily fluids), which has a devastating impact on their lives.
In a newly produced mini-documentary on the subject, Rafika, a fistula survivor from Pakistan, describes her experience of living with the condition as follows: “[My urine leakage] became so heavy that all my clothes, my room and the kitchen used to get dirty…I couldn’t enjoy anything anymore.” But the misery of living with fistula does not stop here. Many women and girls who suffer from the condition are excluded from daily community life and often abandoned by their husbands and families, isolating them socially and emotionally, also making it difficult to hold down a job, thus deepening their poverty and magnifying their suffering.
Poor women and girls
An estimated two million women and girls are living with fistula in the developing world. A major reason for this is weak and inequitable health systems in countries where the condition is most prevalent. Poor women and girls, particularly those living in rural and underserved areas, commonly are unable to access the vital medical care they need which can prevent and repair fistula, including life-saving emergency Caesarean section surgery. It is this same group who need these services most, as their poverty and vulnerability render them susceptible to poor health, malnutrition, early marriage and childbearing – all important factors associated with fistula.
The solution: prevention, treatment and rehabilitation
The good news is that we know how to completely banish fistula from the world map by following a three-pronged approach of prevention, treatment and rehabilitation. Fistula can be prevented by ensuring that all women who experience prolonged, obstructed labor have access to timely, high quality emergency obstetric care, especially Caesarean section. Additionally, delaying pregnancy until later in life and ensuring healthy spacing of births through the availability of quality, voluntary family planning information and services, and providing universal access to skilled attendance at birth can also help to prevent both maternal deaths and injuries such as fistula.
In most cases, fistula can be surgically repaired and ensuring access to treatment by highly skilled, trained, expert surgeons is a key element in eliminating the condition. Tackling the societal consequences of fistula through a full range of holistic social rehabilitation services to help survivors re-build their lives is also of vital importance.
In recent years, the global Campaign to End Fistula, a coalition of over 90 international partner agencies, led by UNFPA, the United Nations Population Fund has had considerable success in tackling fistula by following this three-pronged approach.
However, significantly increased political will and financial commitment from the international community are needed if these efforts are to be scaled up and fistula is to be eliminated.
EU member states, including my own country of Belgium, are amongst the biggest contributors to the UNFPA. It is vital that existing donor member states sustain and increase their contributions to the Campaign, and that non-donor states consider how contributing can make a real difference in lifting millions of women and girls out of misery.
It is also important that the new overarching development agenda, to be agreed by the international community later this year, has poor, vulnerable, and marginalised women and girls at its centre. The EU is an influential voice at these negotiations and it is vital we fight tooth and nail for the world’s most vulnerable.
It is a grave injustice that fistula continues to be so destructive in poor countries when it has been eradicated in wealthy ones. Such a galling disparity, combined with the fact that we know the successful strategy for defeating fistula, must compel us to end the needless suffering of millions of women and girls in the developing world.
(Hilde Vautmans is a Belgian member of the European Parliament from the liberal ALDE group)
