Although the majority of this week’s readings focused on maternal mortality and neglected tropical diseases, I have chosen to focus my posting on what I view to be one of the most neglected, highly treatable and preventable conditions facing pregnant women in the developing world: obstetric fistula.
Obstetric fistula is a condition resulting in a complicated labor process which leaves the women with a small hole in her rectum or vagina, or both, that causes her to live with a constant leakage of urine and feces. Forced to live out the rest of her days in a puddle of her own excrement, a woman suffering from a fistula is usually abandoned by her husband, family, and community.
Many of these women are sent to live in isolated huts outside the village, with no contact with the outside world. For these women, usually teenagers or children themselves, all hopes of leading a normal and productive life are gone. As New York Times columnist Nicholas Kristof wrote in his October 31, 2009 column, these women have become, “the lepers of the 21st century.”
Now eradicated in most developed countries due to access to surgical obstetric care and skilled delivery, obstetric fistula continues to plague women in the developing world. Kristof estimated in his column that three to four million women around the world are currently suffering from obstetric fistula. One of the most frustrating aspects of this condition is that the procedure to correct a fistula cost about $300 and can take up to 20 minutes in most cases. The fact that such a cheap and quick procedure can so dramatically change the life of a woman suffering from obstetric fistula makes the fact that this condition still exist even more appalling.
Although often operating far away from public perceptions, there are a number of individuals and organizations working towards eradicating obstetric fistula. One of the most successful fistula hospitals to date, the Addis Ababa Fistula Hospital, was founded by Dr. Catherine Hamlin and her husband in Ethiopia in 1974. Dr. Hamlin and the hospital were featured on the Oprah Winfrey show in 2004. Hamlin has also founded the Fistula Foundation. The UNFPA’s Campaign to End Fistula is at the forefront of this movement, now working in over 45 countries to make fistula as rare in the developing world as it is in the developed. I first learned about this condition in the film Love, Labor, Loss, a documentary about obstetric fistula that I screened on my college campus in 2004. There is currently a proposal for a global plan to end fistula circulating in Congress, written by Michael Horowitz of the Hudson Institute and Dr. Lewis Wall, founder and president of the Worldwide Fistula Fund.
This week’s class focuses on the bigger picture of reaching MDG-5, 75% reduction in maternal mortality ratio between 1990 and 2015, which will take billions of dollars to achieve. While we review these large numbers, and seemingly impossible goals, it is less daunting to take a step back and realize that with $300 and 20 minutes, we can change one woman’s life forever.