Obstetric Fistula - History and Epidemiology

History and Epidemiology

Obstetric fistula was very common throughout the entire world. But since the late 19th century, the rise of gynecology developed safe practices for childbirth, including giving birth at local hospitals rather than at home, which dramatically reduced rates of obstructed labor and obstetric fistulas within Europe and North America. The surgery to cure it was developed by J. Marion Sims and perfected by Australian doctors Reg and Catherine Hamlin of the Addis Ababa Fistula Hospital, now the largest fistula repair center in the world.

Adequate population-based epidemiological data on obstetric fistula is lacking due to the historic neglect of this condition since it was mostly eradicated in developed nations. Available data are estimations that should be viewed with caution. According to the Urologic Nursing Journal, 30% of women over age 45 in developed nations are affected by urinary incontinence, primarily caused by obstetric fistulas. The prevalence of obstetrical fistula is much lower in places that discourage early marriage, encourage and provide education of women, and grant women access to family planning and skilled medical teams to assist during childbirth.

Obstetric fistula is still very prevalent in the developing world, especially in sub-Saharan Africa (Kenya, Mali, Niger, Nigeria, Rwanda, Sierra Leone, South Africa, Benin, Chad, Malawi, Mali, Mozambique, Niger, Nigeria, Uganda, and Zambia) and much of South Asia (Afghanistan, Bangladesh, India, Pakistan, and Nepal). According to the World Health Organization (WHO), an estimated 50,000 to 100,000 women develop obstetric fistulas each year and over two million women currently live with obstetric fistula. In particular, most of the two million-plus women in developing nations who suffer from obstetric fistulas are under the age of 30. Between 50% - 80% of women under the age of 20 in poor countries develop obstetric fistulas (the youngest patients are 12–13 years old). Other estimates indicate that there are approximately 73,000 new cases per year.