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The Silent Reality Of Obstetric Fistula — Dr Khine Pwint Phyu, Dr Ganesh Ramachandran & Dr Anitha Ponnupillai

The International Day to End Obstetric Fistula, observed annually on May 23, serves as a reminder of the silent suffering endured by women around the world.

Assoc Prof Dr Khine Pwint Phyu, Assoc Prof Dr Ganesh Ramachandran, and Assoc Prof Dr Anitha Ponnupillai are academics specialising in obstetrics and gynaecology at the School of Medicine, Faculty of Health and Medical Sciences at Taylor’s University. Photos courtesy of Taylor’s University.

KUALA LUMPUR, May 23 – 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 health care disparities.

Within the Southeast 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.

Globally, 65 per cent 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 change their life forever and often face abandonment and ostracisation by the family, friends, and society.

The cause of obstetric fistulas lies in traumatic childbirth experiences. Prolonged and difficult labours subject women to prolonged pressure on the birth canal, resulting in inflammation, tissue damage, and death of cells.

This can lead to the formation of fistulas, creating distressing symptoms such as urinary or faecal leakage, foul-smelling vaginal discharge, and chronic vaginal infections or painful sexual intercourse.

This injury results in extreme physical taboo and even isolation of the individual, which in turn results in emotional and mental burdens causing low self-esteem and depression.

The long-term impact on intimate relations between a husband and wife exacerbate both physical and mental wellbeing of the woman too.

There are several contributing factors that heighten the risk of obstetric fistula:

Limited Access To Skilled Health Care

Inadequate access to skilled birth attendants and emergency obstetric care are main determinants of obstetric fistulas.

Prolonged labour without proper medical intervention can lead to severe birth trauma and fistula formation.

Socioeconomic Challenges

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, teenage pregnancies, and its complications which include fistula formation.

Social Stigma And Cultural Barriers

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 Access To Treatment

Limited trained health care professionals and resources for fistula repair poses a formidable obstacle to timely treatment.

Inadequate health care infrastructure and surgical facilities prolong the suffering of affected women.

To minimise the incidence of obstetric fistulas, the following initiatives must be taken:

Promoting Access To Quality Maternal Healthcare

Strengthening maternal health care services, especially in remote areas, is crucial. Ensuring health care for all, accessible care during pregnancy, labour and after childbirth play a major role in minimising obstetric fistula and other birth-related complications including death due to childbirth and its complications.

Health Education Initiatives

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.

Enhancing Health Care Infrastructure

Investing in healthcare infrastructure, including skilled birth attendants, surgical facilities, and postoperative rehabilitation services, play a crucial role.

Adequate resources and training for healthcare professionals assist in ensuring timely diagnosis, treatment, and rehabilitation of obstetric fistula patients.

Population Studies And Research

Conducting comprehensive population studies on the prevalence and incidence of obstetric fistula 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 both urban and rural areas receive adequate care during pregnancy, labour, and childbirth.

Intensive training programmes for midwives are conducted to ensure the delivery of babies with safe techniques and the timely diagnosis of serious postpartum complications, including obstetric fistulas.

Furthermore, urogynaecology departments have been established in both private and public sectors, staffed with trained urogynaecologists to effectively treat obstetric fistulas efficiently if at all they occur and provide comprehensive rehabilitation services.

It is essential that we break the silence and 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 academics specialising in obstetrics and gynaecology at the School of Medicine, Faculty of Health and Medical Sciences at Taylor’s University.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova.

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