On the first UN-recognized International Day to End Obstetric Fistula, May 23rd, we look at one of the key causes of fistula – child marriage. This practice, which results from deeply entrenched social norms and economic pressures, increases the chances of girls developing this debilitating condition. Tostan is working with partners to build understanding of the condition and promote prevention.
Obstetric fistula refers to the injuries to a women’s birth canal that usually develop due to prolonged and obstructed labor. As well as the emotional trauma of losing a child – in nearly all cases of obstetric fistula, the baby does not survive – women are left with chronic symptoms including permanent incontinence. Other symptoms include infections, infertility, and nerve damage that can limit the women’s ability to walk. Women left untreated can also die as a result of infections or kidney failure.
In many cases, fistula also brings social repercussions which increase the distress caused by the physical consequences. Shamed by their incontinence and often left unable to have children, women may be shunned by their husbands and communities. Many women with fistula become isolated, lack self-esteem and struggle to earn a living, as their condition prevents them from working.
Today, fistula is rare in countries where caesarean sections are widely available. However, the development of fistula can be prevented before medical intervention is necessary, before a woman is even pregnant, by delaying the age of her first pregnancy.
Although not all cases of fistula are connected to giving birth at a young age, up to 65 percent of women with the condition develop it as adolescents. Many girls married at an early age become pregnant shortly afterwards and give birth before their body has fully matured, increasing the chances of an obstructed labor.
In an assessment of nine African countries, UNFPA found that most women seeking treatment for fistula were under 20, some even as young as 13, and had developed the condition during their first delivery. This means that many girls’ lives are affected by fistula, which is permanent if not treated, while they are still teenagers. As 90 percent of births to mothers aged 15-19 take place within a marriage, child/forced marriage can be seen as a major cause of many of these cases of fistula.
According to the World Health Organization, repairing uncomplicated cases of fistula with surgery is successful 90 percent of the time. However, women often do not have access to medical treatment, are unaware of the procedures available, or simply do not have the funds available to get treatment – usually in the range of $100-$400 USD. What’s more, curing the physical problem will not automatically treat the psychological and social issues left behind.
Our Community Empowerment Program provides participants with information on hygiene and health, as well as the harmful consequences of child/forced marriage. These discussions build understanding of fistula and enable participants to make connections that they may not have considered before. With this newly acquired information, participants and their communities – more than 6,400 communities to date across the eight countries in which we work – decide to publicly abandon the practice of child/forced marriage, dramatically decreasing the chances of future generations of girls and young women developing fistula.
In partnership with the Fistula Foundation, we are also currently carrying out a needs assessment in communities in Senegal in order to produce a strategy promoting the prevention and treatment of fistula. The needs assessment will form the basis for a comprehensive fistula prevention and treatment program in the regions of Kedougou, Kolda, Ziguinchor, Tambacounda and Matam. This study will also provide the fistula treatment community with a better understanding of the social, cultural, economic and resource-related challenges that serve as barriers to fistula prevention and treatment, as well as address the issues of social reintegration of women who have received fistula treatment.
A holistic approach, especially one based on human rights that empowers women and girls to make their own decisions when it comes to marriage and family planning, can help to reduce the prevalence of obstetric fistula. The grassroots movement taking place in West Africa and led by communities to abandon child/forced marriage, along with other harmful traditional practices, will play a crucial role in this endeavor.