Today marks the United Nations International Day to End Obstetric Fistula. How many of us have heard of obstetric fistula, let alone begin to imagine the pain and indignity of those impacted by it?
In countries like Ireland with established social and healthcare systems, obstetric fistula is almost eradicated. Yet for some two million women in countries with limited access to quality and affordable health and social care, obstetric fistula is one of the most neglected public-health and human-rights realities.
Briefly, for those who may not be aware, obstetric fistula is the result of prolonged or obstructed labour, which causes an abnormal opening between a woman or girl’s birth canal and her urinary tract or rectum. This physical injury results in urinal and/or faecal incontinence.
As you can imagine, this experience for women and girls is traumatising as it not only means years of persistent incontinence and other medical complications such as prolonged infection, it can also lead to the delivery of stillborn babies and, in some cases, infertility.
In countries where motherhood is key to a woman’s social standing and relevance in her community, this is devastating. And that’s not all. Women and girls who live with obstetric fistula are faced with the longer-lasting damaging lived experiences of injustice and denial of basic human rights and human dignity.
These include mobility impairment, psychosocial repercussions, heightened economic hardship and the social consequences of being stigmatised and isolated from family and community. Most often women/girls are divorced by their husband and/or neglected, shamed, abused and ostracised, which diminishes their self-esteem and capacity to survive.
Much of the attention in responding to obstetric fistula in the past has concentrated on surgery to repair a fistula which, for less complex cases, can have a success rate of 90 per cent.
In Ireland we are aware of the tireless and ground-breaking work of the late Sisters and doctors Maura Lynch and Anne Ward, both Medical Missionaries of Mary, and also the pioneering work of Sr Dr Miriam Duggan of the Franciscan Missionaries for Africa (currently working in Kenya) and Dr Michael Breen, working as a fistula repair surgeon in Madagascar.
Each in turn have dedicated their lives to enabling women and girls in Africa with fistula to live a dignified life, providing critical, specialised fistula surgery.
Yet, only a few women can access or afford the surgery, and not all surgeries are simple. Often the women live in remote rural locations, largely in Africa or south Asia, where quality prenatal care is limited and the prospect of medical support for an obstructed labour is minimal.
Their isolation, along with the limitations of trained medical surgeons to conduct fistula repair, makes the possibility of repair surgery ever more difficult. Then there are the costs associated with getting to a hospital that can provide specialised care, as not all medical professionals in hospitals are trained in fistula repair.
In addition, there is the less discussed need for rehabilitation post-surgery and the critical psychosocial support necessary for women to reintegrate them into their community after years of exclusion. And not to mention the ways in which the women can support their livelihoods.
Violation of rights
Obstetric fistula is much wider than a medical issue. It is a violation of the rights of women in societies across the world who are denied their right to an education, to proper medical care, to movement, to life in their community and, for some, their right to life itself.
The very fact that today, in a modernised, global context, women continue to suffer such a devastating, preventable condition is outrageous. And we should all be outraged.
If we truly are to ‘leave no one behind’, as the United Nations 2030 Agenda for Sustainable Development and its sustainable development goals promises, then we must ensure the inclusion of the two million women and up to 100,000 more each year who experience obstetric fistula.
This means recognising obstetric fistula as both a cause and consequence of the experiences of women who live in rural communities and who are among the most marginalised, neglected members in society.
It is critical to see beyond the condition as a ‘reproductive health’ issue and recognise the wider human development issues that impinge on them accessing their fundamental human rights and basic human dignity.
This includes access to quality education, appropriate health and maternal care, supports for economic independence and improving their subordinate status within their community.
Key to this holistic approach in eradicating obstetric fistula lies in prioritising girls’ education and safeguarding continued educational and livelihood supports that empower and equip girls and women in rural areas to ensure their wellbeing.
Dr Toni Pyke is justice, peace and ecology co-ordinator with the Association of Leaders of Missionary and Religious of Ireland. She has worked on international development and gender issues in the US, Nigeria, South Africa, Uganda and Zambia, as well as Ireland and lectured at Maynooth University and the University of South Africa
Fr Edward Flynn is a Spiritan priest who works on the prevention of obstetric fistula from a human rights context