This diagram shows the areas (in red) where obstetric fistulas commonly occur. — Wikimedia Commons
Obstetric fistula, an excruciating childbirth injury resulting in an abnormal connection between a woman’s birth canal and bladder or rectum, continues to haunt countless lives.
Despite its profound impact, obstetric fistula remains largely unspoken, hidden in the shadows of societal taboos and healthcare disparities.
Within the South-East Asian region, including Malaysia, reliable data remains elusive, making it challenging to ascertain the true prevalence of this condition.
However, empirically, because of the access most women in Malaysia have to good healthcare facilities, obstetric fistulas are exceedingly uncommon in our country.
Devastating impact
Globally, 65% of obstetric fistula cases occur in girls under the age of 18.
It is a devastating childbirth injury afflicting the most impoverished and vulnerable girls and women.
The physical, emotional, psychological, social and economic consequences incurred by experiencing this condition at a younger age changes their life forever, and they often face abandonment and ostracisation by family, friends and society.
The cause of obstetric fistulas lies in traumatic childbirth experiences.
Prolonged and difficult labour subject women to prolonged pressure on the birth canal, resulting in inflammation, tissue damage and cell death.
This can lead to the formation of fistulas, creating distressing symptoms such as urinary or faecal leakage from the bladder or rectum respectively to the vagina, foul-smelling vaginal discharge, and chronic vaginal infections or painful sexual intercourse.
This injury is usually treated as taboo, potentially leading to isolation of the individual, as well as emotional and mental burdens like low self-esteem and depression.
The long-term impact on intimate relations between husband and wife can severely affect both the physical and mental well-being of the woman too.
Complicating elements
There are several contributing factors that heighten the risk of an obstetric fistula:
Inadequate access to skilled birth attendants and emergency obstetric care are the main determinants of obstetric fistulas.
Prolonged labour without proper medical intervention can lead to severe birth trauma and fistula formation.
Poverty and lack of education initiate the burden of maternal health complications.
Vulnerable populations are young women in underprivileged environments who may be subjected to childhood marriages and teenage pregnancies, along with their complications, which include obstetric fistula formation.
Some cultural beliefs and societal stigma surrounding childbirth-related injuries impede timely medical interventions.
Misconceptions and shame prevent women from seeking the necessary healthcare, thus exacerbating the severity of obstetric fistulas.
Limited trained healthcare professionals and resources for fistula repair poses a formidable obstacle to timely treatment.
Inadequate healthcare infrastructure and surgical facilities prolong the suffering of affected women.
Preventive steps
To minimise the incidence of obstetric fistulas, the following initiatives must be taken:
Strengthening maternal healthcare services, especially in remote areas, is crucial.
Ensuring healthcare for all, and accessible care during pregnancy, labour and after childbirth, will go a long way in minimising obstetric fistulas and other birth-related complications, including death due to childbirth and its complications.
Public awareness campaigns and access to education are instrumental in dispelling myths and fostering early recognition of birth injuries.
Empowering women with knowledge about childbirth complications encourages proactive seeking of medical assistance and reduces the stigma surrounding fistulas.
Investing in healthcare infrastructure, including skilled birth attendants, surgical facilities and post-operative rehabilitation services, plays a crucial role.
Adequate resources and training for healthcare professionals assist in ensuring timely diagnosis, treatment and rehabilitation of obstetric fistula patients.
Conducting comprehensive population studies on the frequency and occurrence of obstetric fistulas is essential for establishing accurate regional data.
By identifying causative factors, such research not only sheds light on the root causes, but also helps in curtailing and eliminating the culprits responsible for obstetric fistulas.
In Malaysia, extensive measures are taken to ensure that women in both urban and rural areas receive adequate care during pregnancy, labour and childbirth.
Intensive training programmes for midwives are conducted to ensure that babies are delivered with safe techniques and that serious postpartum complications, including obstetric fistulas, are diagnosed in a timely manner.
Furthermore, urogynaecology departments have been established in both private and public sectors, staffed with trained urogynaecologists to effectively treat obstetric fistulas efficiently if they occur and provide comprehensive rehabilitation services.
It is essential that we advocate for the rights and dignity of women affected by this condition.
Through collective action and consistent commitment, we can minimise the debilitating complications of obstetric fistula, paving the way towards a future where every woman is ensured the right to safe and high-quality emergency obstetric care during childbirth.
Assoc Prof Dr Khine Pwint Phyu, Assoc Prof Dr Ganesh Ramachandran and Assoc Prof Dr Anitha Ponnupillai are obstetricians and gynaecologists at Taylor’s University’s Faculty of Health and Medical Sciences. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
