Obstetric fistulas, a serious women’s condition where a hole develops in the birth canal, most commonly occurs from complications associated with childbirth, especially during prolonged labor when blood flow is cut off to the tissue surrounding the birth canal walls. The danger of developing fistulas increases in the absence of adequate medical care.

According to the U.N. Population Fund (UNFPA), obstetric fistulas annually affect an estimated 10,000 to 50,000 women around the world.

The rate of obstetric fistulas sharply increases in rural areas or villages. A lack of awareness about the condition and its causes appears to be the primary reason for the higher infection rates.

“Health centers are not available in far-reaching, rural areas,” Dr. Khawla Al-Lawzi, the deputy director of the maternity ward in Al-Thawra Public Hospital, said. “Some cases involve women who are in labor for two to three days; in these cases, the women’s body literally just ruptures.”

Most of these fistula cases occur in the absence of proper medical care during childbirth. However, they can also be caused by malnutrition on the part of the mother.

Women less than 18 years old and giving birth for the first time are the most likely group to be affected by the condition. Physical health is also a factor.

Generally, women shorter than 148 cm have a higher risk of developing obstetric fistulas. Another increased risk factor is women older than 40.

Salama, a women from Taiz who suffered from a fistula for 1.5 years, said the cause of her fistula was a home delivery birth and more than 13 hours of labor, from 8 p.m. to 10 a.m.

Effects of An Obstetric Fistula

Women suffering from obstetric fistulas could develop incontinence, an inability to control bowel or urinary movements, which also causes a persistent odor to emit from the body.

“I can’t go out now; urine is always flowing, and I can’t prevent or cover up the smell,” Salama said.

Women could also lose the ability to have normal childbirth again, along with the high risk of developing chronic infections in the reproductive organs or infertility.

A fistula not only causes physical harm to those it affects, it can also affect women psychologically. Divorce and family disownment are both common consequences of the condition. Isolation, embarrassment and depression are often psychological affects associated with a fistula.

“Fistula is also called the silent disease because women usually don’t talk about their situation to anyone because they don’t want others to ostracize them,” Al-Lawzi said.

Salama said she feels rejected by those closest to her, even her husband and sons.

Na’ema, a woman in Ibb who has suffered from the condition for 24 years, said her marriage completely fell apart after she developed a fistula.

“I was content with simply raising my children, but I can’t take the abuse and humiliation from my husband. He treats animals better than me.”

Treatment for the Condition

With the exception of major surgery, few options are available as a solution to recover from fistulas.

“There is a specialized unit in Al-Thawra Public Hospital to conduct fistula operations in Sana’a,” Al-Lawzi said.