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Women's Health and Education Center (WHEC)

Obstetrical Fistulae

List of Articles

  • Global Efforts to End Obstetric Fistula (Part 1)
    Obstetric fistula is a devastating childbirth injury that leaves women incontinent, often stigmatized, and isolated from their communities. It is a stark outcome of socioeconomic and gender inequalities, human rights denial and poor access to reproductive health services, including maternal and newborn care, and an indication of high levels of maternal death and disability. These reviews outline efforts made at the international, regional and national levels, and by the United Nations system, to end obstetric fistula. It offers recommendations to intensify these efforts, within a human rights-based approach, to end obstetric fistula as a key step towards achieving Millennium Development Goal 5, by improving maternal health, strengthening health systems, reducing health inequities, and increasing the levels and predictability of funding. This review addresses magnitude of the problem and efforts at international, national and regional levels. Nongovernmental organizations (NGOs) and faith-based organizations in Africa are comparable to government-run institutions in terms of infrastructure and capacity to deliver obstetric care. Higher rates of obstetrician attendance and cesarean / instrumental delivery occurred at these institutions, potentially indicating better access to lifesaving intrapartum care. Greater recognition and integration of NGOs and faith-based organizations into strategies to improve maternal and neonatal health are essential for reaching international targets.

  • Global Efforts to End Obstetric Fistula (Part 2)
    The review outlines efforts made by the United Nations system and its Member States and remaining gaps. Commitments and efforts of Women’s Health and Education Center (WHEC) are also included. It offers recommendations to intensify these efforts, within a human rights-based approach, to end obstetric fistula as a key step towards achieving Millennium Development Goal 5, by improving maternal health, strengthening health systems, reducing health inequities, and increasing the levels and predictability of funding. Almost all obstetric fistulae occur in resource-poor areas, as a paucity of resources is the root cause. Where there are no suitable facilities for deliveries and obstetric emergencies, obstruction of labor often results in fetal death and obstetric fistula. Treatment in this setting usually focuses on meeting patients’ immediate needs rather than conducting research and refining techniques and long-term management of the patients. Unified, standardized evidence-base for informing clinical practice is lacking.

  • The Obstetric Fistula in the Developing World
    Worldwide obstructed labor occurs in an estimated 5% of live births and accounts for 8% of maternal deaths. Obstetric fistula are predominately caused by a very long, or obstructed, labor which can last several days or even sometimes, over a week before the women receives obstetric care or dies. Globally, over 300 million women currently suffer from short- or long-term complications arising from pregnancy or childbirth, with around 20 million new cases arising every year. This review provides essential, factual background information along with guiding principles for clinical management and program development. We hope to contribute to the development of more effective services for women under treatment for fistula repair. We hope our efforts advance effective programs for eliminating obstetric fistula. Most of all, however, we hope that the contents will motivate future research that will further enhance the understanding of reproductive health.

  • Rectovaginal Fistula and Fecal Incontinence
    Childbirth is increasingly being recognized as commonly injuring the mother's anal sphincter complex. Fecal incontinence also appears to be associated with urinary incontinence and pelvic organ prolapse. Anal continence does not completely depend on intact sphincters; also important are intact neuromuscular function, including a functioning puborectalis muscle and pudendal nerve. This is supported by the fact that some women with sphincter lacerations remain continent. Anatomical knowledge of the anorectal canal is essential. Complications of anal sphincter laceration include anal incontinence, fecal urgency, perineal pain, and sexual dysfunction. Diagnostic studies, non-invasive therapies, and surgical management have all evolved in recent years. This has resulted in an improving outlook for women with this stigmatizing condition.

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