Suellen Miller, CNM, MHA, PhD, is Director of Safe Motherhood Programs, the Women's Global Health Imperative, University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, and Adjunct Assistant Professor, University of California, Berkeley, School of Public Health, Maternal and Child Health Program.
Obstetric Fistula: A Preventable Tragedy
Article first published online: 24 DEC 2010
2005 American College of Nurse Midwives
Journal of Midwifery & Womens Health
Volume 50, Issue 4, pages 286–294, July-August 2005
How to Cite
Miller, S., Lester, F., Webster, M. and Cowan, B. (2005), Obstetric Fistula: A Preventable Tragedy. Journal of Midwifery & Womens Health, 50: 286–294. doi: 10.1016/j.jmwh.2005.03.009
- Issue published online: 24 DEC 2010
- Article first published online: 24 DEC 2010
- cephalopelvic disproportion;
- obstructed labor;
- maternal mortality;
- maternal morbidity
Obstetric fistula disables millions of women and girls in developing countries, primarily in sub-Saharan Africa and South Asia. The United Nations Population Fund (UNFPA) recently launched a global campaign to end fistula, labeling this condition a preventable and treatable tragedy. Obstetric fistula overwhelmingly results from obstructed labor, which occurs in cases of cephalopelvic disproportion and malpresentation. Cephalopelvic disproportion often complicates deliveries in young, primiparous women of low gynecologic age. Social factors, including young age at marriage and malnutrition of girl children, can also contribute to cephalopelvic disproportion. These social etiologies must be addressed by prevention campaigns. Direct prevention of fistula can occur during delivery when skilled providers identify women and girls at risk for obstetric fistula and link them with innovative interventions, such as Fistula Prevention Centers, through which they can more readily access emergency obstetric care, and by setting strict time limits for laboring at home without progress. Community-based programs, such as the Tostan program in West Africa, use social education to prevent fistula. Moreover, effective surgical techniques for fistula repair are available in some settings and should be expanded to reach those in need. Midwives can play a key role in the prevention and treatment of this tragic obstetric complication.