Rising Above Obstetric Fistula In The Face Of #COVID19

By Andrew M.

@makokhaandrew

The rigorous fight to win the war against obstetric fistula and the stigma related to it has been dealt a huge blow especially at this time when the whole world is fighting to stay afloat against the ravaging negative ramifications caused by the seemingly unrelenting COVID-19 pandemic.

According to https://fistulafoundation.org , obstetric fistula is a childbirth injury that destroys a woman’s life. It leaves her incontinent, humiliated and too often shunned by her community.  It occurs when a mother goes through prolonged, obstructed labour but unfortunately doesn’t have access to emergency medical care such as caesarian section. This state leaves the helpless mother labouring in excruciating pain for several days. As if this is not enough, eventually her baby usually succumbs.

In the course of her prolonged labour, a mother’s contractions continually push the baby’s head against her pelvis. Soft tissues caught between the baby’s head and her pelvic bones become compressed, restricting the normal flow of blood. With no sufficiency in blood supply, sections of tissue slowly die, leaving holes, known as “fistulae” between the mother’s vagina and her bladder or rectum. These are the holes that cause incontinence. Unfortunately if untreated, the woman will uncontrollably leak urine, stool, or sometimes both, for the rest of her life.

This sorry state of a woman not being able to control urine, stool or both eventually becomes a painful reference point for ridicule, psychological abuse, physical abuse as well as discrimination from social events in the community. As all these go on, a negative load of rejection and pain accumulates in these women’s hearts and minds leaving them grappling with negative thoughts sometimes as sad as suicide.

This year’s call to action speaks a clear message: “End gender inequality! End health inequities! End Fistula now!” As health systems around the world grapple with the realities of covid19, silently other health services including sexual and reproductive health are slowly being sidelined.

The question that lingers at this point is………How can the whole situation be turned around amidst the challenges in the health crisis and economic nosedive caused by covid19?

The government, through its network and systems can add a little more oomph to community sensitization and legislation against early marriages. Criminalizing early marriages and campaigning against the same will consequently lead to a delay in the age of first pregnancy. Early marriages lead to early childbirth, which increases the risk of obstructed labour since young mothers who are poor and malnourished may have underdeveloped pelvises.

The society should also stop harmful traditional practices, the most pronounced being FGM –female genital mutilation. FGM, according to UNFPA, is a huge contributing factor to the prevalence of obstetric fistula among communities that still practice this culture.

Timely access to obstetric care is also key in ensuring the war against obstetric fistula is won. Whereas it is acknowledged that most pregnancy-related complications cannot be predicted, they can be treated if women have access to quality emergency obstetric care at the time of delivery.

Having said that, it is unfortunate that the current pandemic affects all these preventive measures in developing countries such as Kenya where obstetric fistula still exists. These are countries in which health care systems, even before the coronavirus outbreak, could not adequately provide accessible, quality maternal health care.

Due to the disruptions and economic pressure brought about by COVID-19, it is likely that many vulnerable families will marry off their daughters to alleviate the perceived burden of caring for them, especially in the anticipated economic fallout of the pandemic. This is according to a UNFPA report on http://www.unfpa.org.

As covid19 advances, our health system, which was already in precarious state has stretched beyond measure leaving a limited space for women who urgently need maternal care. With this shift in focus, vulnerable women are left on their own. With all this going on, many women and girls also skip scheduled medical appointments and important medical check-ups for fear of contracting covid19 in the hospital.

Having come to the realization that preventive measures are in danger, it is important for the international community to use the International Day to End Obstetric Fistula to significantly raise awareness and intensify practical actions geared towards ending obstetric fistula in addition to urging follow-up and active tracking of fistula patients.

All said and done, there is so much room for positivity. Yes, obstetric fistula exists but fortunately, it can be treated.

With every stakeholder doing their part, this is a war that SHALL be WON!