frequently asked questions

What causes fistula to occur?

Fistula (VVF and/or RVF) results from prolonged, obstructed labor. It occurs when a woman is unable to deliver her baby safely and cannot access emergency obstetric care, including a cesarean section. The constant pressure of the baby's head causes the tissues to disintegrate between the vagina and the bladder and/or between the vagina and the rectum. Top

What are the effects of fistula? As a result of the long labor, the baby almost always dies. The injury leaves the mother leaking urine and or feces uncontrollably from the vagina. In addition, the constant leaking of urine can lead to blistering of the genital area. Prolonged labor may also cause a condition known as "foot drop" - extreme nerve damage to the lower limbs - making it difficult or impossible for women to walk. Beyond these physical consequences, fistula often exacts a severe social toll, resulting in divorce or abandonment and varying degrees of social isolation. It is not uncommon for women with fistula to work, eat and sleep alone. Top

What are the coping strategies of girls and women with fistula?

Despite the challenges of living with fistula, girls and women are typically strong and resilient. They continue to support their families and themselves. They carry on with physically demanding work, including finding and hauling water and firewood, cooking, farming and caring for family members. They may spend years saving money to pay for both medical care and transportation to a facility providing treatment. Top

Can fistula be cured?

Fistula can be cured. Surgery can yield success rates of over 90% when carried out by a trained provider, with the proper medical equipment and supplies. The biggest challenge faced by many women is in reaching a health facility that has a doctor trained in fistula repair. Countries with a high rate of fistula have acute shortages of trained health care providers and health facilities overall. Top

What does "gender and health equity" mean?

Equity ensures that all people have equal rights and access to resources and opportunities. It includes special attention to the most disenfranchised members of society.

Gender equity enables girls and women to make independent decisions about their health, education, marriage, childbearing, and economic security.

Health equity provides fair and equal access to high-quality health care services for all people, and it includes specific measures to safeguard the health of the poor. Top

What does fistula have to do with poverty and with gender and health equity?
A range of socio-economic factors can increase a woman's risk of fistula. The condition is most likely to affect women with scarce income, minimal control over personal or family finances, and limited access to basic medical and obstetric care. Women that cannot easily travel to hospital facilities, either because of long distances, high costs of transportation or lack of decision-making power in the family, are at an increased risk. Malnutrition and early childbearing are also thought to contribute to fistula, because the small size of the mother's pelvis may make it difficult for the baby to pass through the birth canal. Fistula is more likely to occur in countries that have severely constrained financial resources, spend small portions of their budgets on health and social services, or use limited resources inefficiently. Corruption and misuse of funds compromise effective service delivery, particularly for the poor. Fistula and other conditions affecting the poor will begin to improve when marginalized people can influence how services are delivered and how public funds are spent. Top

How can fistula be prevented?

The best way for a woman to avoid fistula is by having access to high-quality antenatal care, and by delivering at a health facility with trained providers and adequate equipment. Emergency obstetric care is an essential component of fistula prevention for women with pregnancy and delivery complications. The lack of adequate roads and unreliable transportation systems also contribute to complications of childbirth, because it makes it harder for women to reach health care facilities quickly, particularly in an emergency.

Strengthening social and economic systems that underlie women's health and rights is also crucial. Programs that build gender equity, ensure educational achievement, and provide the basis for women (and men) to secure a livelihood all help to prevent fistula and other conditions affecting the poor. Top

How can I learn more about fistula?

For further information about fistula and its relationship to gender and health equity, please contact Women's Dignity Project.