The Most Natural Thing In the World?


As the daughter of a nurse I had some vague idea of what a fistula might be (my mother always liked to tell us the ‘real’ name for everything.)  A fistula is a hole – usually a tear – between organs.  To be honest, I can’t say that I was all that aware of obstetric fistulas.

An obstetric fistula is a tear that develops between the rectum and/or bladder and vagina as a result of prolonged or severe childbirth.  The physical result of this tear is that woman – many of them teenagers too young to be physically capable of giving birth without medical intervention – leak urine and feces all the time.  The social result of this is that they are usually divorced and ostracised. Because they smell bad, they are forced to live in huts at the edge of their villages where they starve or die of infection.

“The woman with a fistula is the modern day leper,” as a healthcare worker describes the situation.(1)

Obstetric fistulas were not unknown in Europe and America – for example, the present day site of the Waldorf-Astoria Hotel in Manhattan, was once the site of the Women’s Hospital of New York, which specialised in fistula repair until it closed in 1928. (2)

Since the early twentieth century in the Western world, the condition of obstetric fistula has been relegated to obscurity by the availability of medical intervention in childbirth. Obscure enough that this nurse’s daughter was never warned about them by her mother.

This is not the case for thousands of other women around the world (regardless of who their mothers may be).  They know exactly what an obstetric fistula is and all about the devastation it wreaks on a life.

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(1) Half the Sky, Nick Kristoff and Sheryl WuDunn, p. 109

(2) http://www.hipmama.com/node/25230