Fistula now a ‘dual burden’ on Bangladesh as C-sections rise

Bangladeshi women are now facing the “dual burden” of fistula – one is related to poverty, and the other to wealth.

Nurul Islam
Published : 13 Feb 2018, 06:10 PM
Updated : 23 Feb 2018, 07:28 PM

Poor women who lack access to healthcare during childbirth mostly suffer ‘obstructive fistula’, which is a childbirth injury caused by prolonged obstructed labour.

But, study suggests ‘iatrogenic fistulas’, which are related to caesarean sections, and hysterectomy, surgical removal of the uterus mostly for tumours, are also emerging.

“In fact, we (in Bangladesh) are facing dual burden of fistula,” Dr Sathyanarayanan Doraiswamy, Chief of the UNFPA Bangladesh’s health section, told citing a study.

One is related to poverty and the other which is related to caesarean section is affecting mostly the rich who can afford surgical deliveries, he said.

He spoke on the issue on the heel of the 2nd Hope Maternal Health and Fistula Conference ended in Cox’s Bazar on Feb 11.

Bangladesh is devising strategies to end the debilitating condition within 2030 with the support of the UNFPA.

Erin Anastasi

Erin Anastasi, Coordinator of the global Campaign to End Fistula, UNFPA headquarters in New York, told that obstetric fistula had been wiped out from the developed world.

“It now mainly affects poor women without access to adequate and skilled birth attendants,” she said in Dhaka where she came to attend the conference.

A fistula is a hole between the vagina and the bladder or rectum, through which urine or stool leaks continuously.

It usually happens when women do not have access to quality emergency obstetric care services and deliver at the hands of unskilled attendants.

According to a recent study done by ICDDR’B, there are 19,755 cases of obstetric fistula in Bangladesh, two-thirds of which are among women between 15-49 years of age.

Data from the National Fistula Center and three major hospitals in Bangladesh as studied by Fistula Care Plus indicated that 27 percent of fistulas were iatrogenic from 2012 to 2014

Most of them were caused by poor quality hysterectomies and caesarean section, which have seen an alarming rise in Bangladesh.

Sathyanarayanan Doraiswamy

The latest Bangladesh Maternal Mortality survey found delivery by C-section increased dramatically to 31 percent in 2016 from 12 percent in 2010, an abnormal rise as WHO says 10 percent to 15 percent of the total deliveries may be C-section because of complications.

In private facilities, which mostly refer complicated cases to government hospitals, C-sections accounted for 83 percent of deliveries, which means that lure of money pushes those surgical deliveries.

Identifying fistula patients can be challenging as there is a lot of stigmas attached to it and women are often ostracised from their communities, unable to work and therefore, earn a livelihood.

“The poorest of the poor are the worst hit,” Anastasi said before adding they face isolation in society and cannot come out for treatment.

She suggested a four-pillar approach to ending fistula as the government’s strategy with the support of the UNFPA is at the final stage.

Prevention, the treatment which is surgery, social reintegration so that they can go back to their community where they live, and advocacy at the national level to raise awareness are those pillars, according to her.

She said among the developing countries where fistula is common, Bangladesh has “better chance” to end this.

“This is because of the government’s leadership (showed by devising strategy), the introduction of the midwifery service to ensure safe, normal delivery at all level, available family planning services and also vibrant civil society bodies.”

Anastasi suggested incorporating private sector in the process of fighting fistula.

“UNFPA will always support the government with its technical expertise and funding,” she assured.