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[New York, New York], United Nations, General Assembly, 2008 Aug 6. 20 p. (A/63/222)The present report was prepared in response to General Assembly resolution 62/138. Obstetric fistula is a devastating childbirth injury that leaves women incontinent and often isolated from their communities. It is a stark example of continued poor maternal and reproductive health services and an indication of high levels of maternal death and disability. The report outlines efforts to end obstetric fistula at international, regional and national levels, including by the United Nations system. It concludes with recommendations to intensify efforts to end obstetric fistula as part of support to the achievement of Millennium Development Goal 5, including strengthening health systems and increasing levels and predictability of funding.
[New York, New York], United Nations Population Fund [UNFPA], 2008. 35 p.Obstetric fistula, almost unknown in the industrialized world, is most common in poor communities of sub-Saharan Africa and Asia where emergency obstetric care is rarely accessible. It occurs when a woman undergoes a difficult and prolonged labour without prompt medical intervention. Left incontinent, women with fistula are often abandoned by husbands and loved ones and blamed for their condition. Their babies are usually born dead. Like maternal death, obstetric fistula is preventable. Averting it will also contribute to safer childbearing for women throughout the developing world.This publication covers topics such as: 1. Advancing Maternal Health and Rights; 2. Preventing Harm; 3. Healing Wounds; 4. Renewing Hope; 5. Harnessing Momentum.
New York, New York, Family Care International, 2007.  p.This publication explores knowledge, attitudes, and perspectives on pregnancy, delivery, and fistula from 31 country-level needs assessments conducted in 29 countries in the Campaign to End Fistula (see inside back cover for the complete list). Experiences of women living with obstetric fistula, their families, community members, and health care providers are brought to light. This information represents important research on the social, cultural, political, and economic dimensions of obstetric fistula, drawing attention to the factors underlying maternal death and disability. We hope this publication will serve as an advocacy tool to strengthen existing programmes and encourage further research on how to increase access to vital maternal health services, including fistula prevention and treatment. We implore policy makers, programmers, and researchers to listen to these women's voices and consider the promising practices and strategic recommendations described herein. What we have learned so far can help point the way, but much more still needs to be done. We cannot afford to wait-the costs to women, communities, and health systems are simply too great to delay action. Too many of the world's most disadvantaged and vulnerable women have suffered this preventable and treatable condition in silence. Too many women are dying unnecessarily in childbirth. It is time to put an end to the injustice of fistula and maternal death. (author's)
Obstetric fistula: Guiding principles for clinical management and programme development, a new WHO guideline.
International Journal of Gynecology and Obstetrics. 2007 Nov; 99 Suppl 1:S117-S121.It is estimated that more than 2 million women are living with obstetric fistulas (OFs) worldwide, particularly in Africa and Asia, and yet this severe morbidity remains hidden. As a contribution to the global Campaign to End Fistula, the World Health Organization (WHO) published Obstetric fistula: Guiding principles for clinical management and programme development, a manual intended as a practical working document. Its 3 main objectives are to draw attention to the urgency of the OF issue and serve as an advocacy document for prompt action; provide policy makers and health professionals with brief, factual information and principles that will guide them at the national and regional levels as they develop strategies and programs to prevent and treat OFs; and assist health care professionals as they acquire better skills and develop more effective services to care for women treated for fistula repair. (author's)
Eritrean women's project response to wall paper: "hard questions concerning fistula surgery in third world countries" [letter]
Journal of Women's Health. 2007 Mar; 16(2):281-282.We read with interest Dr. Wall's editorial, "Hard Questions Concerning Fistula Surgery in Third World Countries."1 Dr. Wall has correctly identified the major issues in performing fistula surgery in the developing world, which include adequate preparation and screening of patients, appropriate logistical support (including anesthesia, sutures, catheters, equipment required for complicated vaginal abdominal surgery), and excellent postoperative follow-up, which mandates medical and surgical training for both local physicians and nurses in the hospitals where such surgery is to be performed. Given Dr. Wall's concern about "fistula tourism," we would like to provide the readers of this journal with a more complete description of our program, which has been designed as a sustainable program to address not simply surgical repair but also the issue of prevention, which remains paramount. Prevention is the only way to restore dignity to women of Africa along with the ability to have families without suffering the devastating consequences of obstructed labor. (excerpt)
BMJ. British Medical Journal. 2006 Jul 1; 333(7557):8.Hundreds of thousands of women in developing countries suffer the devastating injury during child bearing of obstetric fistula. But the agency behind a global campaign to eradicate the condition says it is simple to prevent and easy to treat. The global campaign, led by the international development agency the United Nations Population Fund, has launched a month long advertising drive in the United Kingdom to raise awareness of a condition that is believed to affect between 50 000 and 100 000 women each year. Obstetric fistula is usually caused by several days of obstructed labour without prompt medical intervention and leaves the woman with agonising, long term pain, chronic incontinence, and--in most cases--a stillborn baby. (excerpt)
New York, New York, UNFPA, 2005.  p.Obstetric fistula is a heartbreaking injury of childbearing. It occurs when a woman endures obstructed labour--often for several days--without appropriate medical intervention. The consequences are life shattering: The baby usually dies, and the woman is left with chronic incontinence. This tragedy occurs because the sustained pressure of the baby's head on the mother's bladder or rectum damages soft tissues, creating a hole--or fistula--that leaves the woman unable to control her flow of urine, or faeces, or both. The smell often drives husbands and loving family members away. In many communities, women with fistula are considered "unclean" and stigmatized. Without treatment, their prospects for work and family life are greatly diminished. One of the tragedies of fistula is that it frequently affects adolescent girls. They are at greater risk of complications during childbirth and tend to have less access to health services. Young girls who thought they had full lives ahead of them suddenly find themselves marginalized and alone. (excerpt)
Demographer John Caldwell and the Addis Ababa Fistula Hospital win 2004 United Nations Population Award.
Population 2005. 2004 Jun; 6(2):12.Well-known Australian demographer, John C. Caldwell, and the Addis Ababa Fistula Hospital, a pioneer in the treatment of childbirth injuries, have won the 2004 United Nations Population Award. The Award is given annually to individuals and institutions for their outstanding work in the field of population and in the improvement of the health and welfare of individuals. The Award Committee, chaired by Ambassador Iftekhar Ahmed Chowdhury of Bangladesh, selected the two winners after a review of nominations received from around the world. The Committee is made up of Member States of the United Nations, with UNFPA, the United Nations Population Fund, serving as its secretariat. Each winner will receive a certificate, a gold medal and an equal share of a monetary prize. Awards will be presented to winners in July at a ceremony at the United Nations Headquarters, New York. (excerpt)
Population 2005. 2003 Dec; 5(4):16.In July 2002, the United States government withheld $34 million in funding for the United Nations Population Fund (UNFPA). According to UNFPA, the withheld U.S. funds could prevent 4,700 maternal deaths, 60,000 serious maternal illnesses and more than 70,000 infant and child deaths. Without this crucial funding from the United States, UNFPA, with a budget of only $270 million worldwide, will struggle financially to adhere to women throughout the world. Jane Roberts of California and Lois Abraham of New Mexico both independently struck up the idea of a grassroots campaign to raise the $34 million that the U.S. withheld from UNFPA. The goal of the 34 Million Friends of the UNFPA campaign is to enlist 34 million Americans to send one dollar to UNFPA to show support for the organization’s important work worldwide. With the campaign in action for almost a year and a half, 34 Million Friends has raised over $1.5 million as of December 2003. (excerpt)
Lancet. 2003 Dec 31; 363(9402):71-72.The advent of modern obstetric care has led to the eradication of obstetric fistula in nearly every industrialized country. However, in the developing world obstetric fistula continues to cause untold pain and suffering in millions of women. The very existence of this condition is the result of gross societal and institutional neglect of women that is, by any standard, an issue of rights and equity. In the developing world, obstetric fistula is almost always the result of obstructed labour. During prolonged obstructed labour the soft tissues of the pelvis are compressed between the descending baby’s head and the mother’s pelvic bone. The lack of blood flow to these tissues leads to necrosis and ultimately a hole forming between the mother’s vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal), or both, that leaves her with urinary or faecal incontinence, or both. Early intervention to relieve obstructed labour will restore perfusion to these tissues and, in most cases, will prevent fistula. The results of fistula are devastating. In nearly every case the baby is stillborn. Women and girls with fistula are unable to stay dry. They smell of urine or faeces and are shunned by the community and, at times, even by their own husbands and families. They remain hidden, shamed, and forgotten. (excerpt)
The second meeting of the Working Group for the Prevention and Treatment of Obstetric Fistula, Addis Ababa, 30 October -1 November, 2002.
New York, New York, UNFPA, 2003. 38 p.Much of the meeting was devoted to presentation of needs assessments from 12 African countries. Nine countries were surveyed by Engender Health; the African Medical and Research Foundation surveyed Kenya; and the Women’s Dignity Project assessed the situation in Tanzania. Dr. Catherine Hamlin and Ruth Kennedy also presented information about the situation in Ethiopia. The assessments provide a clear and informed base—for the first time—on which to build a realistic plan of action to combat fistula in the region. This information should also help to bring the tragedy of fistula out from under its shroud of shame and secrecy. We expect this will result in increased support for many of the best programmes already in place in Africa and in the creation of a regional network for fistula prevention and treatment. (excerpt)
Lancet. 1989 Jun 10; 1(8650):1316-7.Vesicovaginal fistula (VVF), commonly caused by prolonged obstructed labor, is one of the worst complications of childbirth. Afflicted women continuously leak urine and sometimes feces, excoriating their mutilated vulvas and vaginas and often becoming social outcasts. Until the early part of this century, VVF was common in the United States and European countries, but today it is rarely encountered in developed countries. It is still, however, a major problem in many developing countries, where it is generally caused by neglect and mismanagement in labor. As many as 300 women suffering from VVF come to gynecology clinics for treatment every month in some areas of northern Nigeria. But many doctors do not wish to deal with VVF and their Western training does not equip them to perform needed surgery. The major thrust of research and development of services must be in prevention of VVF. But much can be learned about the disorder through treatment of its victims, and their suffering in and of itself demands a major treatment effort. This will require establishment of specialized centers, including hostel accommodations. International and national teams of medical experts would go periodically to needy areas to train local surgeons, advise on difficult cases, and help reduce patient backlogs. Such a program can only be set in motion through funds provided by international organizations. A WHO working group on VVF recently recommended urgent measures to prevent the disorder and to clear the backlog of patients waiting for operations. And an organization known as the VVF Initiative has been established in Nigeria and is in need of practical and financial assistance.