Poverty – a determinant and consequence of ‘obstetric fistula’

“Obstetric fistula can be explained to result from different causes. These holes in the tissue wall between the vagina and bladder and/or rectum are most prevalent in resource-poor countries, attributable to prolonged obstructed labour and absent or inaccessible remedial prenatal services. Obstructed labour is often due to small pelvic size, resulting from women's youth and premature childbearing and/or malnutrition. Poverty at national health-service and family levels often predisposes pregnant populations to suffer high rates of fistula. Global estimates showing up to 100,000 new cases each year and 2 million affected girls and women are probably gross underestimates. Fistula devastates lives of sufferers, who are often expelled by husbands and become isolated from their families and communities. Failures of states to provide prenatal preventive care (including medically indicated caesarean deliveries) and timely fistula repair violate women's internationally recognized human rights, especially to healthcare in general and reproductive healthcare in particular.”

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2004.07.005 

Poverty is still prevalent and plentiful in our society. Despite fifteen years of the Millennium Goals and seven years of the Sustainable Development Goals, despite the trojan work of many individuals, development organisations and UN Agencies, despite the improved prosperity, technical and electronic resources in our world, poverty is still pervasive.

Poverty is a constant in our history. Hunger and homelessness in our cities, a lack of resources in remote rural areas. We have it in many forms and it destroys lives and restricts the potential of many individuals.

It is in this context of poverty that we find the greatest number of young girls and women living with obstetric fistula. And because they live in small hamlets and settlements in isolated locations, their situation is not often reported in the papers. As they are not in the consciousness of the public they receive less attention from government services and politicians.

It is not easy to reach many of these people. Where roads exist, they tend to be of inferior quality and are not well maintained. There are few public transport facilities in these regions and it is a big investment for impoverished peoples to have even a basic form of motorised transport.

While poverty may not be a direct cause of ‘obstetric fistula’, it is a strong determinant. And the use of scarce financial resources by women to have operations to repair a fistula can lead to a deepening of poverty. Being forced to sell farm animals – a valuable resource – to gain access to medical treatment has a devastating effect on a fragile family economy.