Obstetric Fistula: A Preventable Tragedy

Obstetric fistula is a devastating child-birth injury that affects thousands of women annually. 

An obstetric fistula is a hole created between the birth canal and the bladder or rectum that results in leakage of urine or feces. Often caused by prolonged labor or a lack of adequate obstetric care, this preventable condition disproportionately affects women in low-resource countries.

Those who suffer from an obstetric fistula experience both physical and emotional trauma. Many women with the condition are shunned from their families or communities. This exacerbates existing issues of poverty and isolation. 

The Center for Global Health and Social Responsibility’s Global Women’s Health Initiative has done extensive work to lessen the prevalence of obstetric fistula and provide education and resources related to the condition. 

May 23 is the International Day to End Obstetric Fistula. We talked with CGHSR Director of Global Women’s Health Rahel Nardos, MD, MCR, to learn more about obstetric fistula and her work supporting global maternal health. 

You’ve done a lot of work focused on obstetric fistula. What interested you in the condition in the first place? 

I grew up in Ethiopia in the 1970s and 80s. At that time we had a communist government that put most of its resources to the endless war effort. That meant that healthcare was not a priority. I was acutely aware of the negative impact of poor healthcare infrastructure. 

At the time, Ethiopia had one of the worst maternal outcomes among low-income countries. Later on in my training, I learned that even if women managed to survive childbirth, if they don’t have access to timely obstetric care, particularly access to c-section for obstructed labor, they suffered devastating birth injuries to their bladder and bowel causing them to leak urine and /or stool constantly. This is what obstetric fistula is. It is completely preventable with access to timely and quality obstetric care. 

After I completed my OBGYN residency training in the U.S., with encouragement from my mentor Dr. Lewis Wall and support from the Worldwide Fistula Fund, I was fortunate enough to spend a year working at the Hamlin Fistula Hospital in Ethiopia. This was incredibly eye-opening to me. I saw firsthand the devastating impact of obstetric fistula on women and their families, and how it is possible to restore their dignity through compassionate holistic care. 

I went on to serve on the board of Worldwide Fistula Fund for eight years and have continued to collaborate with them and our various obstetric fistula partners in Africa since. 

Obstetric fistula is a devastating condition. Could you talk about the effects it has on women not just physically but also emotionally? 

Indeed. Many obstetric fistula patients have told me that they have at times felt that death was better than living with this condition. 

The injury is associated with a hole in the bladder or rectum leading to constant leakage of urine and or feces. If the injury is severe, it is also associated with nerve and musculoskeletal injuries that make it difficult and sometimes impossible to be physically or sexually active. 

But just as traumatic is the psychological and social trauma. Patients are usually isolated, and ostracized because of their condition. This leads to high mental health burden and vulnerability to gender based violence. The majority of fistula patients deliver stillbirth and continue to carry the burden of grief for a long time. 

Obstetric fistula is preventable, yet it still affects hundreds of thousands of women. Why is this? 

This is truly one of the most unforgivable tragedies of our times. We know how to prevent obstetric fistula. We have already eradicated this problem in high-income countries by making quality obstetric care available for women in a timely manner. But this is not the case in low-resource countries where women, particularly in rural communities, still continue to give birth at home or in healthcare facilities that are not well equipped to manage obstetric emergencies.  

We can prevent obstetric fistula by empowering women and girls to make reproductive choices, by raising the health literacy of communities, by building a well-trained and compassionate healthcare workforce and by improving health systems so that quality and timely obstetric care is possible. None of this can be possible if families, communities and nations don’t prioritize safe pregnancy and childbirth as the most important investment for the future of any society.  

What role does healthcare professional training play in lessening the likelihood that women suffer from obstetric fistula?

Healthcare professionals need to be not only technically skilled but also skilled in respectful communication with patients and other healthcare teams. They need to be leaders and advocates in their environment to make sure that the system is well equipped to provide safe and timely care. 

This will require that we provide the kind of training that emphasizes patient-centered care while making continuous feedback and improvement part of the culture. When our healthcare environment is more humane and made up of highly capable and caring healthcare teams, patients will have more trust in their clinicians and will seek care early to avoid complications. 

Of course, no amount of training of healthcare professionals will be successful without investing in the infrastructure and resources needed to provide safe and timely obstetric care.

CGHSR’s documentary film, Fistula: A Film to Promote Better Maternal Health Care Globally, was an official selection at the World Health Organization’s Health for All Film Festival in 2024. Learn more about CGHSR’s Global Women’s Health Initiative