Obstetric fistula could be a curse from the book of Job, if Job were a woman: A girl or woman is in labor in rural Africa. Forced to marry when still a child, she is only 13 or 14. Or she is 18 or 20, but malnutrition has stunted her growth. Her pelvis is too small to allow the baby to pass, and she has at most a traditional birth attendant to help her; her obstructed labor lasts days. Sometime during this agony the baby dies, and, eventually, the lifeless body is delivered. The mother, exhausted and grieving, might assume the worst of her physical suffering is over. Then she discovers that the worst may have just begun.
The prolonged pressure of the baby’s head in the birth canal killed tissue, causing a hole between the vagina and bladder or rectum. Urine or feces leak constantly. The odor becomes overwhelming. The woman is likely rejected by her husband. Without medical help, she spends the rest of her life on the fringes of her community.
Precise counts aren’t available, but an estimated 2 million women have obstetric fistula worldwide. Between 50,000 and 100,000 new cases occur each year, mostly in sub-Saharan Africa and parts of Asia. Fistula is virtually nonexistent in countries with widely available emergency obstetric care. Most fistulas occur in childbirth, but others come from the use of rape as a weapon of war, as in Congo and Sierra Leone.
The root causes of fistula are extreme poverty, inadequate health care, and the low social status of women, which deny them basic rights, education, and the capacity for self-determination. For example, when girls are allowed to continue their education at least through adolescence and delay marriage until adulthood, their risk of complicated childbirth is drastically lowered.