Here on The Chirp we talk a lot about the causes of bladder leaks (aka incontinence) for women in developed countries. But we love broadening our perspectives here at Lily Bird and understanding the experiences of all women. So, today our friends from Beyond Fistula will share a different a common cause of bladder leaks in developing countries: the fistula. Take it from here, Nell.
What Is A Fistula?
Ever heard of an obstetric fistula? If you haven’t, you’re not alone. A fistula is a hole in a woman’s reproductive tract that results from a prolonged, obstructed labor. A few different situations make a difficult labor way more likely.
For example — if the woman gives birth in a rural area without access to medical help, if she is very young and her pelvis is underdeveloped to be giving birth, or if she is small because she is malnourished. As you can imagine, all these cases are much more likely in developing countries where child marriage is common. An estimated 2 million girls and women are currently suffering with a fistula.
What Causes A Fistula?
The nitty gritty of the process is that that the baby’s head is too large to pass through the birth canal, and, with no midwife or doctor there to help turn the baby or do a C-section, the mother pushes and pushes, sometimes for days, without making any progress. Amidst the pain and blood loss, the baby usually doesn’t survive. The pressure of the baby’s head against the birth canal cuts off blood supply to the mother’s tissues, causing them to die. This is where a hole develops.
The most common fistulas are between the vagina and bladder or between the vagina and rectum. As you can imagine, this causes women to leak urine or feces. Often a woman has no idea that she has developed a fistula. She just wakes up from the nightmare of a painful labor, with a stillborn baby, and notices that she is in a puddle and cannot control her urine. Tragically, since fistulas are much more likely in areas where women give birth without medical help, they disproportionately affect poor women in Asia and Sub-Saharan Africa. In developed countries, we eradicated fistulas over a hundred years ago through prevention and treatment.
What Is The Impact Of A Fistula?
In much of Africa in particular, fistulas are thought to be a “curse” or the “fault” of the woman, deserved for “dirty” or “bad” behavior. Whole communities will shun a woman with a fistula, her husband will divorce her, and often her father will not let her back into his home due to shame. There is a tremendous emotional burden borne by women with fistulas, and many of them become depressed and even suicidal.
Fistulas also impact women economically. If a woman is a merchant or has a business within her community, the foul odor and the stigma drive away her customers. More often, women in these areas depend on a husband or a father’s money. With no means of earning her own money and no education, she has few options once cast off. Perhaps she was only a girl when she became pregnant, and she had to drop out of school. Then she is stranded without an education or a future. Plus, these women are treated horribly, devoid of value if they cannot bear children. And most don’t even understand why they are leaking in the first place. It is a lonely, bleak situation, soaking through rags 24/7 and drowning in shame and secrecy.
Is There Treatment?
But there is some good news: fistulas can usually be fixed with a single surgery costing around $600.
There are several amazing nonprofits working in Africa and Asia to fund and provide these surgeries. They do essential outreach work to spread awareness and provide treatment. As for the emotional, economic, and social repercussions of fistula
, that’s where we at Beyond Fistula
In 2010, Ob/Gyn Dr. Debbie Matityahu met Dr. Hilary Mabeya while traveling Kenya with her family. Dr. Mabeya and his wife, Carol, had founded a fistula treatment hospital in northwest Kenya to provide surgeries to women suffering with fistula. In meeting patients, Debbie saw clearly that these women needed help that went beyond the operating room. She and Carol joined together to hire a small team of social workers and vocational skills teachers to help girls and young women rebuild their lives after fistula surgery.
Since then, Beyond Fistula has grown to encompass a business skills training, a farming program, and a scholarship program for girls wishing to return to school. We work with many other fistula nonprofits across Kenya to help these incredible women back to their feet, to restore their dignity, and to lift them toward a life beyond fistula.
By Nell Maynard