Isobel Coleman

Democracy in Development

Coleman maps the intersections between political reform, economic growth, and U.S. policy in the developing world.

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Combating Obstetric Fistula

by Isobel Coleman
May 23, 2013

An Ethiopian woman sits on her bed inside a clinic for obstetric fistula in Bahir Dar on March 10, 2007 (Eliana Aponte/Courtesy Reuters). An Ethiopian woman sits on her bed inside a clinic for obstetric fistula in Bahir Dar on March 10, 2007 (Eliana Aponte/Courtesy Reuters).


Today is the first International Day to End Obstetric Fistula. To be honest, I was not very familiar with the tragedy of fistula until about a decade ago, when I met the remarkable Dr. Catherine Hamlin, who has devoted her life to treating the problems of fistula in Ethiopia. More on her work below, but for those of you who don’t know what this terrible condition entails, I refer you to the UNFPA explanation:

One of the most serious injuries of childbearing is obstetric fistula, a hole in the vagina or rectum caused by labour that is prolonged–often for days–without treatment. Usually the baby dies. Because the fistula leaves women leaking urine or feces, or both, it typically results in social isolation, depression and deepening poverty. Left untreated, fistula can lead to chronic medical problems.

Around 50,000 to 100,000 women develop obstetric fistulas every year–a result of poverty and lack of access to maternal healthcare. The majority of these cases are in sub-Saharan Africa, Asia, and the Middle East. Though fistula is usually treatable at low cost (the surgery and aftercare cost an average of $300), some two million women currently suffer from the condition. In the absence of intervention, fistula can destroy a woman’s life: her loss of control over basic bodily functions leads to ostracism from society.

Some particularly determined individuals have strived to bring fistula out of the shameful shadows and treat it as the curable medical condition it is. Dr. Catherine Hamlin founded the Addis Ababa Fistula Hospital in 1974 with her husband, Dr. Reginald Hamlin. The hospital has performed over 30,000 fistula surgeries with a success rate of above 90 percent. As Hamlin describes in an interview with PBS, women’s husbands often do not understand how prolonged labor caused the fistula in the first place and are unaware of treatment options. Many of these women are cast out of their homes, forced in shame to return to live with their parents or in isolation from the rest of the community. Hamlin tells the story of a woman who had not been out of the mud hut she lived in for nine years as well as of a woman who had suffered incontinence from fistula for four decades before finally being cured by an operation at age sixty.

Women in some countries—often conflict-affected—also experience what is known as traumatic fistula, a consequence of particularly brutal sexual violence. In eastern Congo, for instance, after the 2003 truce in the conflict there came into effect, health experts became aware of widespread traumatic fistula cases caused by the extreme physical trauma of rape, described as a common “weapon of war.” In these cases, psychological and physical recovery can be exceptionally difficult, to say the least.

The United Nations recognizes a wide range of international days, and individual countries add many more. Despite this plethora of official UN occasions, I applaud marking today to highlight the problem of fistula because it is both such a terrible condition and also so treatable.

Post a Comment 2 Comments

  • Posted by betsy

    One of the best tools to combat fistulas is enforcing the legal age of marriage and not tolerating child bride forced marriages. Very young mothers are at highest risk for this pregnancy complication. Educate girls! And educate boys about how to be better husbands and fathers, too.

  • Posted by Isobel Coleman

    Absolutely. CFR just released a new report on child marriage:

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