Obstetric Fistula in the Democratic Republic of the Congo: Neglected Care of Young Women in Rural Areas

Abstract

AbstractObstetric fistula (OF) is a condition that most commonly affects women living in resource-poor countries where access to Emergency Obstetric and Newborn Care (EmONC) is difficult for a variety of reasons. It continues to cause pervasive physical, emotional, and social suffering for many women. The exact prevalence in the Democratic Republic of the Congo (DRC) is not known, but the United Nations Population Fund (UNFPA) estimates that 40,000 women suffer from obstetric fistula. The DRC is a developing country where a large part of the population lives in rural areas and there is widespread poverty. This rural setting is characterized by under-qualification of antenatal clinic staff and lack of access to surgical interventions including cesarean section. At the sociocultural level, this environment is characterized by ethnocultural beliefs that regard as sacred early marriage, home delivery, and vaginal birth, the latter praised as the method of delivery whatever the cost. Women with obstetric fistula are often very young, primiparous, and low-educated who have had parturition at home assisted by an untrained traditional birth attendant. Similar to other countries where obstetric fistula occurs, they are often subsequently stigmatized and abandoned by their partner. The obstetric fistula is often vesico-vaginal and repaired after several years. Although the success rate after surgical repair of obstetric fistula is high, its management remains the preserve of non-governmental organizations because no national program exists in the DRC at present. Thus, national strategies focused on prevention are much more important for the definitive eradication of this devastating disease in our country.KeywordsObstetric fistulaPregnancy complicationCentral AfricaDemocratic Republic of the CongoHaut-Katanga ProvinceMaternal morbidityEpidemiologyRural womenPregnancyObstructed deliveryStigmaSurgical treatment