Hesperian Health Guides
How We Can Stop Obstetric Fistula
Wait to get married. Many girls are married at too young an age and this leads to becoming pregnant before they finish growing. A girl under the age of 16 may have a pelvis that is too small for a baby to fit through during birth. It is better physically to wait longer to have children, and that is why ending child marriage can prevent fistula. By opening up education to girls and encouraging them to stay in school, they can prepare for a better life instead of being married off early. Young women should not be married before they are fully grown and large enough to deliver babies safely.
Improve nutrition for everyone, especially girls. When there is not enough food, children’s bodies do not grow as they should. Often during scarcity, girls are given less to eat. Improving nutrition will help girls have healthy babies later when they are adults.
Make family planning available. Women and girls should be able to get family planning and birth control so they can avoid pregnancy before they are fully grown, when they do not feel healthy enough, or when they do not want to have children or become pregnant. Especially girls who are married young should have access to birth control at community clinics. Husbands and fathers should know that if girls wait until they are fully grown to get married and have children, they and their babies will be healthier.
Get pre-natal care. Meeting with your midwife or doctor several times during your pregnancy can help you stay healthy and know in advance if you have any particular problems that might lead to fistula developing during childbirth.
Women of small stature. It is important that if a woman is small (shorter than 150 cm or 5 feet tall) or has narrow hips, she should go to a hospital to give birth or at least be very close to a hospital in case she needs a caesarean birth (C-section). Giving birth in a hospital can be as safe, or safer, than birthing at home, and having a caesarean birth will not affect a woman’s fertility. A hospital with well-trained health workers can prevent fistula from labor that lasts too long.
Make abortion safe and legal. When abortion is illegal, girls who are too young, as well as girls and women who do not wish to be pregnant, are forced to get unsafe abortions from untrained people. A fistula can happen when a poorly trained person makes a hole in the bladder during a Dilation and Curettage (D&C) procedure, whether for an abortion or to remove a retained placenta.
Make a birth plan. All women, not just those concerned about fistula, can make a plan so they and their families know what to do when it is time for a woman to go into labor. Preventing too-long labor prevents other problems besides fistula, such as death of the mother or the baby being born with a disability.
You can begin to make a birth plan by answering these questions:
- Where will the birth take place? Where will you go if there is an emergency? Will you have to pay fees and how much?
- What supplies and medicines are needed? Who will provide them?
- Will you need transportation to the hospital or clinic? How much will it cost?
- Will you need permission to make the decision to go to the hospital? How can you make sure you can get this whenever labor starts?
- Who will take care of your other children, and your animals and crops, while you are in labor? While recovering after birth?
Know the signs of too-long labor or blocked labor. If a woman has been in labor for more than 8-12 hours, or is pushing for more than 1 hour, yet the baby is not coming, she should go to a hospital to deliver. If the woman does not get help to deliver, she could die or get a fistula, and the baby could die. If help is far away, make sure to include in your birth plan the hours you will need to travel, and therefore how early you have to leave if there are problems.
Stop female genital cutting (FGC or FGM). In some places, cutting practices are done on young women. This cutting does not speed labor or improve reproductive or sexual health. Instead, it causes serious emotional and physical problems, including fistula. Talk with midwives, birth attendants, and doctors about how genital cutting damages women’s health and should not be done. Help people learn about safe ways of giving birth.
As a village health worker, you should respect local traditions and culture because they have helped the people survive. However, it is also important to share your knowledge and let others know when traditional or modern practices cause more harm than good.
Help people help themselves. When people learn about how their bodies work and how they can improve their health, they are usually excited to put those ideas into practice and to share the information with others. If you educate people by using your skills and knowledge in a kind and helpful manner, you will motivate them to behave the same way. Speak with female and male leaders and support them. Help them talk about fistula with their families and friends. When people understand what causes fistula, how it can be prevented, and how it can be repaired, it will no longer harm women in the community.