Why Eliminating GBV is Key to Ending Obstetric Fistula in Africa
Today is the International Day to End Fistula. An estimated 50,000 to 100,000 women are affected each year by obstetric fistula, which is an abnormal opening between a woman's vaginal system and her urinary tract or rectum that usually occurs as a result of lengthy and obstructed labour. In Sub-Saharan Africa, three out of every 1,000 women of reproductive age are likely to have a fistula. Fistula has major physical, psychological, and societal consequences. Ninety per cent of fistula-related pregnancies result in stillbirth.
Women with fistula endure discrimination in their community and a lack of social support, which can lead to divorce, ostracism, and loss of money or work. As a result, women can experience mental health problems such as anxiety and become suicidal.
Fistula is easily preventable and can be avoided by delaying the age of the first pregnancy, discontinuing harmful traditional practices, and providing women with prompt access to obstetric care. Preventing and treating obstetric fistulas helps to improve maternal health (SDG #3-promoting health and well-being).
Gender-based violence, including physical, sexual, and intimate partner violence, including coerced sexual assault and physical abuse while pregnant, is a major threat to women's lives and well-being.
Harmful practices such as female genital mutilation/cutting, as well as child, early, and forced marriage, increase the risk of early onset of pregnancy which can lead to problems during childbirth such as prolonged bleeding, obstructed labour and infections. These can lead to long-term gynaecological issues such as fistulas and infertility and even death.
Women with fistula are frequently rejected by their spouses and scorned by their community due to their terrible odour and inability to carry further children. They are also more vulnerable to gender-based violence since, because of their fistula, they are forced to live apart from their community, increasing their vulnerability.
Child, early, and forced weddings increase the risk of fistula because child brides are frequently unable to negotiate safe sex or family planning, and are exposed to early and unplanned pregnancy and sexually transmitted illnesses. Because their bodies are not fully developed for childbirth, they are more prone to experience protracted labour and obstetric blockage.
Every year, an estimated 12 million girls (22 girls per minute) marry before the age of 18, and if this trend continues, the global number of women married as children will reach 1.2 billion by 2050. Child brides are more likely to drop out of school, endure intimate partner and family abuse, be food and economically insecure, and face higher degrees of social isolation.
An estimated 736 million women and girls—about one in three—have experienced statutory, sexual abuse, domestic abuse, or other forms of violence at least once in their lives. Additionally, millions more are or are at risk of forced marriage, human trafficking, and female genital mutilation.
While the extent of the two problems — GBV and fistula — is distinct, they are interconnected – eliminating harmful practices can help lower the prevalence of fistula. Adopting a holistic approach through a comprehensive health care service that combines GBV support services as a health issue rather than just a police or legal issue would ensure that women and girls who suffer from these tragic conditions receive the attention and support they require.
Surgical procedures continue to be the predominant method of fistula healing. However, many women are unable to obtain the procedures due to long waiting lists, a lack of financial resources to travel to facilities where these surgeries are provided, or they may be unaware that such interventions exist. In many cases, the women may lack the financial means to pay for the procedures and post-operative care.
There is also a scarcity of experienced doctors available to perform reconstructive surgery. This means that at the current rate of progress—only an estimated 20,000 reconstructive procedures are performed each year—many women and girls may die before receiving therapy. The realities of the COVID-19 pandemic made it harder to access life-changing surgeries in most communities as the procedures are termed elective (and not life-saving) interventions.
Non-invasive therapies should be combined in order to achieve full recovery and health including fulfilling the women’s emotional and physical needs. This could include therapies that support fistula survivors with their psychosocial and socioeconomic needs, such as providing them with the required skills, literacy, job training, and health education to assist women to reintegrate into their communities, reconstructing their lives, and restoring their dignity and optimism after suffering a fistula.
To eradicate fistula, prevention is essential. Putting a stop to FGM/C, forced, child and early marriages, and other types of gender-based violence will go a long way towards achieving this aim. Ensuring skilled care at all births and giving high-quality obstetric care to women who develop problems during delivery can limit the prevalence of fistula.