Dr David Richmond, RCOG President, writes…
This Friday is UNFPA International Day to End Obstetric Fistula.
Obstetric fistula is almost entirely preventable and indeed, in the UK, as in most industrialised countries, it has been all but eliminated and many people won’t be familiar with it. Yet it is estimated that the condition affects approximately 2 million women and girls worldwide with between 50,000 and 100,000 new cases each year.
Obstetric fistula is a hole in the birth canal that occurs when the baby becomes stuck during labour. In nearly all cases, without access to prompt medical intervention, it results in the death of the baby and leaves the woman suffering from severe health problems, including chronic incontinence and the shame, social exclusion and economic deprivation that often go hand in hand with this.
We are under no illusion that the persistence of fistula in developing countries is simply due to a lack of medical care during pregnancy and labour, although access to hospitals, doctors and transport are significant factors. It is also linked to wider, more complex issues relating to reproductive health rights, gender equality, poverty and often the low esteem in which women and girls are held in many societies. Whilst we realise that our work in this area has to be part of a wider effort to improve maternal mortality and morbidity generally, the RCOG is a proud and determined official global partner of the UNFPA Campaign To End Fistula.
Along with our partners, the International Federation of Gynecology and Obstetrics (FIGO), the United Nations Population Fund, EngenderHealth and the Pan African Urological Surgeons Association, we have developed a structured course to help train people to treat obstetric fistula. The programme is being piloted in Tanzania, Bangladesh, Ethiopia, Nigeria and Senegal and we hope that it will lead to a standardised approach to medical and surgical management of this condition and ultimately improve outcomes for women and girls worldwide.
Many of our Fellows and Members are involved in obstetric fistula care, both in prevention and treatment, in many countries all over the world and this year we are proud to launch the RCOG Marcus Filshie Fellowship, which is our sponsored International Fellowship at Kitovu Mission Hospital in Uganda. This position will support the delivery of obstetric and gynaecological services, as well as the fistula service.
There is no doubt that in the long term, social and economic development will be more cost-effective and sustainable than medical treatment for fistula. But until there is universal access to emergency obstetric services; until women and girls are empowered both socially and economically; until women have the right to control their bodies and their fertility through access to a range of modern contraceptive methods; and until girls receive universal access to education, they will continue to suffer death and injury during childbirth, and the international medical community cannot simply sit back and allow this suffering to happen.
Over the last few years, raising awareness of obstetric fistula worldwide has led to advances in treatment and training and has helped improve the lives of thousands of women and girls living with this debilitating condition. On 23 May, please visit the RCOG website, view and share our new film which is dedicated to promoting awareness of the problem of fistula, and read the stories of women from all over the world who have been affected by this condition. As a leading college in women’s health, we need to highlight this issue and bring an end to obstetric fistula worldwide.