Causes of obstetric fistula

Causes of obstetric fistula

One of the major causes of fistula is one that is also closely linked to maternal mortality; that of obstructed labour. Obstructed labour occurs when the pelvic of the mother is too small to enable the baby to be delivered without help. Estimates are that obstructed labour occurs in 5% of the life births and accounts for 8% of the maternal deaths. One specifically vulnerable group to develop obstetric fistula is young women, because their pelvises are not fully developed yet. 
When obstructed labour occurs it can last for days, during which the unrelenting pressure of the baby’s head against the mother’s pelvis reduces the blood supply to her bladder, rectum and vagina. When the woman manages to stay alive during this horrific process the baby dies and decomposes by which it becomes soft enough to slide out of the vagina. Because the damaged pelvic tissue also rots away a hole /fistula remains between the adjacent organs.
 
Other, less often occurring, causes of fistula can be sexual violence when sticks, branches of trees or pieces of glass are forced into te woman's vagina, unsafe abortions or trauma after a caesarean section.
 
 
Female genital mutilation
Harmful traditional practices such as female genital mutilation can be seen as an important social causes of fistula. Through the cutting of vaginal and vulval tissue the vagina outlet becomes surrounded with thick scar tissue which increases the likelihood of obstetric complications like obstructed labour. Not only cutting headed under genital mutilation but also incisions made by traditional midwifes during the birth process with knifes, razor blades or pieces of broken glass may cause fistulas. Usually these interventions are based on believes that that’s best way to prepare the vagina for delivery, or to make room for the baby. 
 
Other social causes of OF are traditional early marriages and childbirth. In many countries of the African continent girls are supposed to get married at a young age, sometimes even as young as ten years. Pregnancy is often a direct consequence of marriage and usually takes place right after the marriage convenant has closed. Because of the young age of many of these girls their body is not yet full grown and not prepared to deliver a child, which increases the risk of OF.
 
Armed Conflict and OF 
The intimate link between the age of the mother when first pregnant and her health status has been shown multiple times. In areas where armed conflicts arise an increase in OF-cases is to be expected, not only because of sexual violence and its consequences but alto through forced marriages. Today many Syrian families force their young daughters into a marriage with a husband aged not uncommonly three or four times that of the girl. Research carried out by UN WOMEN[1] shows that one in three of surveyed Syrian refugee women had been forced into early marriage before they reached the age of 18. On the one hand families hope, through forced marriage, to protect their daughter(s) and their family name, since chances of rape and subsequently shattered honour increase significantly in times of conflict. On the other hand the dowry often to the family of the girl enables them to feed mouths in times of scarcity. Economic arguments, one person less to care for, strengthened between family-relationships and extra help for the husband’s family are other motives families might chose to ‘sell’ their daughter. As with other marriages the girls often get pregnant right after they joined their new families. Their young bodies, together with often coexisting health problems like under nutrition and underweight[2], increase the risk of developing OF during the delivery.  
 
 
 

[1] UN WOMEN. (2013). Gender-based violence and child protection among Syrian refugees in Jordan, with a focus on early marriage. Retrieved on October, 3, 2013, from: http://reliefweb.int/sites/reliefweb.int/files/resources/Report-web.pdf.


[2] WHO. (2006). Obstetric fistula. Guiding principles for clinical management and programme development. Retrieved on September 25, 2013, from:http://whqlibdoc.who.int/publications/2006/9241593679_eng.pdf.  

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