HIV/AIDS & Reproductive Health
Reports from the World Health Organization (WHO) estimate that over half a million women die in pregnancy or childbirth every year and a 1.4 million barely survive life-threatening complications in developing countries.
WHO identifies the major causes of these maternal deaths as haemorrhage, sepsis, hypertensive disorders of pregnancy, unsafe abortion and obstructed labour which is responsible for obstetric fistulas, a devastating condition sustained by women during childbirth.
According to the state of Uganda Population Report 2011 that was launched last week, most women with fistula are economically vulnerable with little or no money to access health facilities.
“The constraining factors in ensuring women deliver from health facilities were lack of money, high transport and hospital charges,” the report reads.
Obstetric fistula is a medical condition that is deeply rooted in women’s social, cultural and economic vulnerability. Previous studies reveal that most women with fistula are young, poor and live in rural communities.
According to the report, women constrained by poverty face numerous barriers in accessing adequate health care for example: lack of knowledge to recognise pregnancy and labour complications, powerlessness to seek care, prohibitive costs of transport and health services and low expectation of the care they deserve, among others.
“Because of financial limitations, many women suffering from fistulas are unaware that surgical treatment is available and cannot afford treatment and may live with the condition for a decade,” the report reads.
Obstetric fistula develops when the head of the foetus compresses the soft tissues of the mother’s vagina, bladder and rectum against the pelvic bones during prolonged obstructed labour.
Thereafter, the impacted vaginal wall sustains pressure, tears off and leaves a hole between the vagina and bladder (vesico-vaginal fistula) or between the vagina and rectum (recto-vaginal fistula). If a prompt caesarean section to relieve the obstruction is not done, the foetus suffocates and dies.
According to the Demographic Health Survey (2006), 2.6% of women of reproductive age (15-49 years) had experienced an obstetric fistula.
This means that over 3.5 million women are suspected to be living with the condition.
In a 2003 assessment on obstetric fistula, it was noted that because nothing was being done for fistula patients, they tended to keep away from hospitals and stayed in communities making it difficult for them to be identified. The report attributes the increase to the fact that midwives and nurses lacked necessary skills, equipment and medication to perform safe deliveries.
“Many of the doctors interviewed pointed out that one nurse would be expected to look after 70 or more patients which makes her give little attention to a particular woman,” reads the report.
Many rural women shun hospitals and health centres for fear of being insulted and humiliated by medical personnel after hearing horror stories from their peers.
Patients also complain that the costs of repairing fistula are high. The Shs 40, 000 that rural hospitals charge is beyond some people’s means and patients complain that even when treatment is free, they incur expenses in the form of gifts to motivate medical personnel.
What can be done?
The report recommends different measures to reduce this problem, including: ensuring service delivery in remote areas and a policy that ensures benefits like housing, electricity, and transport in a bid to motivate service providers; fistula repairs need to be made more accessible and affordable; there should be fistula repair centres established and publicized and the government should train more health personnel in this area; and referral systems that are managed by local authorities need to mobilise transport to help affected persons reach health facilities for remedial medical action.
“What can be done today is to start a vigorous health education campaign through outreaches in the most vulnerable communities,” the report says.