A Human Rights Approach Toward Eradicating Obstetric Fistula: Expanding Data Collection, Prevention, Treatment, and Continuing Support for Women and Girls Who Have Been Neglected

Abstract

AbstractGreat achievements have been made in maternal health across the globe; however, regional disparities persist, and 94% of maternal deaths occur in low and lower-middle-income countries. Persisting maternal health disparities reflect significant global inequities, and for every maternal death, an additional 20–30 women suffer from maternal morbidities, which can negatively affect their quality of life. One of the most debilitating and devastating childbirth injuries is obstetric fistula, in which a hole forms in the vaginal tissues during prolonged, obstructed labor and leads to chronic incontinence of urine and/or feces. In addition to the physical suffering of their incontinence, women with obstetric fistula are often stigmatized, and this can lead to worsening social, psychological, and economic consequences. Additionally, their intimate relationships are impacted and they are unsure of their ability to achieve a future pregnancy. Thus, divorce and separation are common. Like many other maternal morbidities, obstetric fistula is completely preventable; therefore, it is rarely seen in settings with access to skilled emergency obstetric care. Obstetric fistula has been a neglected public health and human rights issue, but recent awareness and advocacy efforts have propelled progress in reducing the global burden of obstetric fistula. As more women have gained access to skilled attendance at birth and access to skilled obstetric fistula repair has improved, these gains suggest we can successfully eradicate obstetric fistula by 2030. However, if we are to fully address why women unnecessarily suffer from a preventable and treatable childbirth injury, we must recognize obstetric fistula persists because it is an issue of human rights and social justice. Although obstetric fistula can be prevented, women continue to endure this childbirth injury because there is a lack of political will to prioritize the sexual and reproductive health and rights of women and girls.KeywordsObstetric fistulaChildbirth injuryMaternal morbidityMaternal mortalityObstructed laborIncontinenceQuality of lifeRepairPreventionTreatmentReintegrationHuman rightsSexual rights