Poverty, inadequate health care services, lack of knowledge about maternal health and pregnancy-related emergencies are fuelling the problem of obstetric fistula in Tanzania, according to a report released last week by the nongovernmental organization EngenderHealth and the Tanzania Women's Dignity Project.

Physicians can repair a small fistula surgically in less than two hours, but repairing a larger fistula and restoring a woman's continence sometimes requires more than one surgery. According to the report, titled "Risk and Resilience: Obstetric Fistula in Tanzania," the fetus dies in nearly all fistula cases.

For the report, researchers in 2006 conducted case studies of 61 girls and women living with fistula in the Singida Rural, Songea Rural and Ukerewe districts of Tanzania. The report also included studies of the women's families, health care providers and community members.

According to the report, lack of preparation for childbirth, including basic information, increases women's risk of fistula. In addition, although prenatal care is widely available in Tanzania, it is inconsistent and inadequate, the report found.

Barriers to "facility-based delivery,” including lack of money, distance to a hospital and transportation are the "critical reasons why women ... do not get the care they need," according to the report. The report also found that surgery to repair fistula is expensive and inaccessible for many women in the country and urged that fistula repair services be available at no cost or at reduced prices.

The report also found that women living with fistula and their families had substantial emotional and economic effects because of stigma and the cost of care.

Source: Kaiser Network 18/Jun/07