OB FistulaEvery year on May 23rd, the world comes together to observe the International Day to End Obstetric Fistula. This day sheds light on a profound yet often overlooked healthcare crisis affecting millions of women, particularly in sub-Saharan Africa and Asia. An obstetric fistula is a devastating condition that deeply impacts the lives of affected women, their families, and communities. By raising awareness and working towards prevention and treatment, this day aims to promote dignity, restore health, and empower women.
Understanding Obstetric Fistula

An obstetric fistula is a childbirth injury that occurs because of prolonged, obstructed labor without timely medical intervention. This condition arises when prolonged pressure is applied on the mother's pelvis, cutting off blood supply to the surrounding tissues. The lack of blood flow leads to tissue death, resulting in a connection, or fistula, between the birth canal and either the rectum or bladder, and sometimes both.

The consequences of obstetric fistula are devastating. Women affected by this condition suffer from continuous, uncontrollable leakage of waste, including urine and/or stool. This leads to chronic infections, skin irritation, and a foul odor, often leading to social isolation, depression, and immense emotional trauma. In many cases, these women are ostracized by their communities and denied opportunities for education and economic independence.

Obstetric Fistula in Africa

While obstetric fistula can occur in any part of the world, it disproportionately affects women in sub-Saharan Africa. Factors contributing to this higher prevalence include limited access to quality maternal healthcare, lack of skilled birth attendants, young marriages, poverty, and inadequate transportation to health facilities.

In sub-Saharan Africa, many women live in remote areas with limited healthcare infrastructure, making it challenging to access timely obstetric care. Insufficient obstetric care and the absence of skilled birth attendants during deliveries increase the risk of prolonged labor and obstructed childbirth, leading to obstetric fistula.

Additionally, child marriages prevalent in some African regions exacerbate the issue. When young girls become pregnant before their bodies are fully developed, they are at higher risk of complications during childbirth, including obstetric fistula.

The Impact and Stigma

The impact of obstetric fistula extends beyond physical health challenges. Women living with this condition often face social ostracization and discrimination due to cultural norms, lack of awareness, and prevailing stigmas surrounding reproductive health issues.

The stigmatization associated with obstetric fistula creates a cycle of silence and shame, preventing affected women from seeking help. Their exclusion from family and community life further deepens their sense of despair, isolation, and loss of self-worth.

Addressing Obstetric Fistula: Hope and Healing

Efforts to eradicate obstetric fistula focus on multiple fronts, including prevention, treatment, and the empowerment of affected women. Organizations like the World Health Organization (WHO), UNFPA (United Nations Population Fund), the Worldwide Fistula Fund, and countless local NGOs are working tirelessly to make a difference.

Holly Richter

Holly E. Richter, PhD., M.D., a physician and professor in the UAB Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, has been a board member of the Worldwide Fistula Fund since 2017. She has traveled to Africa to perform surgeries on patients with obstetric fistulas since 2004. Her efforts have brought hope, healing, and a chance at a better life for these women.

An obstetric fistula is a condition that requires surgical intervention for effective treatment. However, in many areas of Africa, education, and resources are lacking, making it challenging to provide adequate care to affected women. Richter recognized this critical gap and along with others has committed to act, using her skills and experience to make a difference. During her time in Africa, she has visited several medical centers in Niger, Ghana, Liberia, Sudan, Nigeria, Uganda, and Zambia to perform countless fistula repairs and reconstructive surgeries.

Performing Fistula Surgeries

Performing surgeries for obstetric fistulas can be complex and demanding. The tissue surrounding the affected area often consists of unhealthy scar tissue, making the procedure even more challenging. However, Richter's and other providers’ dedication and skills have allowed them to navigate these complexities, providing life-changing surgeries for countless women.

When Richter embarks on her trips to Africa, she is not alone. She has typically taken an urogynecology fellow with her, enabling knowledge sharing and capacity building. Additionally, she works with local medical professionals in the area, which has allowed her to sustain her efforts and provide essential post-operative services to patients.

Beyond Surgery: Comprehensive Care

Richter's commitment to her patients extends beyond the operating table. In various fistula hospitals that she has worked in, the patients she sees are typically offered "reintegration" programs, providing aftercare and support to women recovering from surgery. These programs play a vital role in helping women regain their dignity, confidence, and social acceptance after enduring the emotional and physical trauma of obstetric fistula.

Understanding the importance of sustainability, Richter and her colleagues also expend effort on training local doctors in Africa on the surgical techniques required to address obstetric fistula. By sharing her knowledge, she helps build a network of skilled professionals who can continue providing care long after she has returned home.

Looking Ahead

Richter's commitment to improving the lives of women with obstetric fistulas is an inspiration to the medical community. Through her compassionate care, she has forged connections, built partnerships, and empowered countless women in Africa. Her work is a testament to the transformative power of medicine, compassion, and cross-cultural collaboration and a reflection of UAB’s support of initiatives such as this.

Prevention efforts involve improving access to quality maternal healthcare, promoting family planning services, and enhancing community awareness about the importance of timely medical intervention during childbirth. Treatment and rehabilitation programs can also provide life-changing surgeries, postoperative care, and social reintegration services. These interventions aim to restore physical health and self-esteem, empowering women to reclaim their lives.

The International Day to End Obstetric Fistula serves as a vital reminder of the urgency to address this debilitating condition that affects millions of women, primarily in Africa. By increasing awareness, supporting prevention strategies, and expanding treatment options, we can strive towards a future where no woman must suffer the physical, emotional, and social consequences of obstetric fistula.