Why fistula persists among rural women
By Polycarp Machira
A study conducted in Ruvuma and Shinyanga regions recently shows that fistula complications are rampant in the rural communities as the majority of residents have little or no knowledge about the disease.
Fistula remains one of the problems among pregnant women despite efforts to reduce mortality rate arising from it, according to the Women`s Dignity report in November.
``They (women) have to walk long distances in search of health centres, forcing some of them to deliver on the way. Such mothers are also handled in unhygienic manner or die before reaching hospital.
``Fistula is a problem that mostly affects women in rural areas where the women have no access to health services while ignorance and tradition prevail over common sense,` says Christine Mulandwa, the director of Women`s Dignity.
Many women are ostracized by their families and communities, and even banned from using public transport because of the smell caused by the disease.
But some men still believe having many children is a sign of wealth and know little that many births are a cause of increased fistula complications.
Unaware that their problem can be fixed with surgery, or the fact the symptoms of the disease can be alleviated with something as simple as cotton underwear with plastic and an absorptive sponge sown inside, they have endured months or years hiding in shame.
Government statistics shows that only 94 per cent of pregnant women attend pre-natal clinics. Out of them, only 46 per cent deliver safely and the rest succumb to fistula complications.
Dr Christine Sanga, deputy director, Reproductive and Child Health from the ministry of Health and Social Welfare attributes the increased maternal death rate in the country to fistula.
``Maternal mortality ratio stands at 578 out of 10,000 live births and neo-natal rate is above 32 out of 1000 live births.`` she said.
She said major direct causes of maternal mortality include obstetric hemorrhage, obstructed labour, hypertension, sepsis and abortion complications.
According to the World Health Organization, two million girls and women around the world live with fistula, almost all of them in developing countries.
The NGO, the Fistula Foundation, estimates 100,000 new cases appear every year worldwide, but only 6,500 women are treated due to lack of money and doctors.
It is estimated that two million girls and women live with obstetric fistula worldwide, yet fistula remains one of the most neglected issues in women`s health and rights.
It devastates lives, causing women, in most cases, to lose their babies and to live with the humiliation of leaking urine and/or feces constantly.
Fistula also affects families: The financial burden of paying for treatment and transport to hospitals, together with the loss of one income-earner, places significant strains on the families of girls and women living with fistula.
Families also suffer stress and worry about the impact of fistula on the girl or woman.
Examining fistula from the perspectives of girls and women living with the condition provides vital evidence on how health care and social systems often fail to meet women`s basic needs.
Fistula affects girls and women of all ages, both at first pregnancy and in later pregnancies.
The median age at which women in the study developed a fistula was 23. Fewer than half of the women were 19 or younger when the fistula occurred.
In addition, about half of the women were in their second or higher pregnancy. Antenatal care services, while widely available and used, were inconsistent and inadequate.
A majority of the women in the study attended antenatal care services nearly all of them at least twice but the services they received were inconsistent and inadequate and differed greatly from Ministry of Health guidelines.
The lack of birth preparedness, including basic information on childbirth and on taking action around ``the three delays,`` increased the risk of obstetric fistula.
According to the recent study by Women`s Dignity, nearly all of the girls and women in the study who began labour at home made at least one move to get appropriate care, and a majority faced multiple delays in reaching a facility with the needed services.
Lack of access to emergency caesarean section posed a great threat to women`s lives. For girls and women in the study, the most commonly cited barriers to facility-based delivery were lack of money and the long distance to the hospital.