• Fast Facts and FAQs

Fast Facts and FAQs

Fistula Fast Facts

• Fistula used to be present in the US and Europe but was largely eliminated in the latter part of the 19th century and early 20th century with improved obstetric care in general and the use of caesarean sections, in particular, to relieve obstructed labour.
• The World Health Organisation estimates that approx. 2 million women have untreated fistula and that approx. 100,000 women develop fistula each year. Fistula is most prevalent in sub-Saharan Africa and Asia.
• In Ethiopia alone there are an estimated 100,000 women suffering with untreated fistulae and another 9,000 women who develop fistulae each year.
• Less than 6 in 10 women in developing countries give birth with any trained professional such as midwife or doctor. In Ethiopia only 1 in 10 women has a trained attendant. When complications arise, as they do in 5% of all births, there is nobody available to treat the woman leading to disabling injuries like fistula and even death.
• The root causes of fistula are grinding poverty and the low status of women and girls. In Ethiopia poverty and malnutrition in children contributes to the condition of stunting where the skeleton, and therefore pelvis, do not fully mature. This stunted condition can contribute to obstructed labour and therefore fistula.
• But fistula is both treatable and preventable. The Addis Ababa Fistula Hospital has treated over 30,000 women since it was founded. Our cure rate is over 90%. Fistula can be prevented if women in labour are provided with adequate emergency obstetric care when complications arise.

Frequently Asked Questions – FAQ’s

What is an obstetric fistula?

A fistula is an opening or a hole between two areas of the body that should normally be separated. An obstetric fistula, of the kind that occurs in Ethiopia and other developing countries, is a hole between a woman’s birth passage and one or more of her internal organs. This hole develops over many days of obstructed labour when the pressure of the baby’s head against the mother’s pelvis cuts off the blood supply to the delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her vagina and bladder (called a vesicovaginal fistula or VVF) and sometimes between her rectum and vagina (rectovaginal fistula, RVF). This hole results in permanent incontinence of urine and/or faeces. Most women who develop fistulae are abandoned by their husbands and ostracised by their communities because of their inability to have children and their foul smell.

Can fistula be “cured”?

Yes. An obstetric fistula can be closed with intravaginal surgery. If the surgery is performed by a skilled surgeon, a fistula patient has a good chance of returning to a normal life with full control of her bodily functions. The Fistula Hospital has a 93% success/cure rate.

How much does it cost to treat a fistula?

At the Addis Ababa Fistula Hospital it costs on average US$450 to provide each woman with a fistula repair operation, high quality post-operative care, a new dress and her bus fare home.

What are the causes of obstetric fistula?

A fistula results from an obstructed labour that is left unrelieved and untreated. It is estimated that 5% of all pregnant women worldwide will experience obstructed labour. In affluent countries emergency obstetric care is readily available. In many developing countries where there are few hospitals, few doctors and poor transportation systems and where women are not highly valued, obstructed labour often results in the death of the mother. If she survives, there is a high probability that her child will die and she will develop a fistula. According to the United Nations Population Fund (UNFPA) there are three delays that contribute to the development of a fistula: delay in seeking medical attention; delay in reaching a medical facility; and delay in receiving medical care once at a health care facility.

Are fistulae a result of female genital mutilation (FGM)?

No, the two are not linked. FGM makes the external opening at the end of the birth canal much smaller. The woman may suffer from difficulties in delivering the baby and more serious tearing of the skin, which can also create injuries and infection but this is not obstetric fistula. The injury that results in an obstetric fistula happens further up the birth canal when the baby’s head gets stuck as it tries to pass through the pelvis.

How many women does this problem affect?

Because fistula affects women in the most remote regions of the world, and because women with fistula are often hidden away in isolation, an accurate count is very hard to achieve. The most common estimate is that 100,000 women worldwide develop fistulae each year, although some estimates put the number closer to 500,000. We estimate that there 9,000 new cases each year in Ethiopia alone. Most fistula sufferers are young women – many still in their teens – so they are likely to live with their condition for upwards of 25 years. By any estimate there are at least 2 million women living with fistula throughout the developing world. The world capacity to treat fistula is estimated at 6,500 fistula repair surgeries annually.

Where is fistula prevalent?

There is a high incidence of fistula in sub-Saharan Africa and parts of Asia, but women are susceptible to developing fistulae wherever there are insufficient emergency obstetric care systems.

Can fistula be prevented?

Any woman who can gain access to emergency obstetric care, such as a caesarean section, will not develop a fistula. This is why we are building mini-hospitals in five Ethiopian provinces to increase the capacity of regional hospitals to provide fistula repair surgery and quality emergency obstetric care. We are also starting a school to train community midwives. They will be able to recognise difficulties early and will have transport to take the women to centres where they can receive care.

What can I do to help?

A donation made to one of our Partner Trusts directly assists in restoring health and dignity to women in Ethiopia suffering from fistula. In addition our Partner Trusts have their own activities and fund-raising programmes which they would love you to support. If you have questions about any of our programmes or activities then please Contact Us.