BMJ  2004;329:1125 (13 November), doi:10.1136/bmj.329.7475.1125

News

Learning from low income countries

Supporting surgery for obstetric fistula

Rebecca Coombes

London

A pioneering centre in Ethiopia that tackles the burden of fistula has become a blueprint for similar services elsewhere in Africa and Asia

The first 150 words of the full text of this article appear below.

Obstetric fistula is rare in Western countries, thanks to the wide availability of caesarean section, but the potentially devastating childbirth injury continues to affect an estimated two million women throughout the developing world.

This type of fistula arises from ischaemia during prolonged obstructed labour. Fistulas can form between the vagina and bladder or rectum, causing continuous leakage of urine or faeces.

Poverty is the main risk factor for fistula, which the World Health Organization has called "the single most dramatic aftermath of neglected childbirth." Most women have little or no access to antenatal or obstetric care, and, once injured, nearly all go untreated, although surgery can cure fistulas. Because of the smell of urine and their inability to have children, the women are often cast out from their communities and left to fend for themselves.

There are 100 000 new cases of such fistulas every year worldwide, but only about . . . [Full text of this article]

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