3. Introduction
• Obstetric fistula (OF) is a condition in which there is an abnormal
opening between a woman’s vagina and bladder or rectum caused
by prolonged obstructed labor.
• OF occurred in the course of pregnancy and results in chronic
incontinence of uncontrolled passage of urine, faeces into the
vagina.
• It’s basically a psychosocial injury.
04/12/2021 3
5. Prevalence
• Obstetric fistula affect more than 2 million young women worldwide.
• 50,000 to 1,00,000 are adding each year.
• In Nepal, 4362 live with obstetric fistula.
• UNFPA and WOREC estimates that there are 200 to 400 new cases of
obstetric fistula in Nepal each year.
• However, the data figure is like a tip of iceberg, as most of the cases are
unreported due to stigma associated with the condition and lack of
knowledge about the treatment.
04/12/2021 5
6. Sings and symptoms
• Flatulence.
• Pain during sexual activity.
• Foul-smelling vaginal discharge..
• Repeated vaginal or urinary tract infections.
• Irritation or pain in the vagina or surrounding areas..
• Urinary incontinence or Fecal incontinence which may be continual or
only happen at night..
04/12/2021 6
7. Risk Factors
• Poverty.
• Pelvic Fracture
• Malnutrition.
• Obstructed labor.
• Lack of education.
• Teenage pregnancy.
• Sexual violence, Rape, Trauma.
• Inflammatory bowel disease. (IBD)
• Lack of quality access to maternal and health care.
04/12/2021 7
9. Prevention
• Providing FP methods.
• Postponing early marriage.
• Ensuring skilled birth attendance.
• Access to health services and education.
• Improved nutrition and outreach programs.
• Promote the practice of spacing between births.
• Ensure access to timely and safe delivery during childbirth.
• Provision of emergency obstetric care, and safe C-section when needed.
• Awareness regarding proper hygiene and care during pregnancy and labor.
04/12/2021 9
11. Obstetric Fistula Management in Nepal
1. Fistula foundation
a) International Nepal fellowship: INF focuses on three main areas in
its work on fistula i.e. surveillance, prevention and treatment of obstetric
fistula in remote areas of western Nepal.
b) Public health concern trust Nepal: It’s a non profit organization
that runs Kathmandu model hospital and kritipur hospital with the
facilities of providing 5 beds and 3 surgeons.
04/12/2021 11
12. 2. UNFPA campigan Nepal
a) Advocacy and awareness raising: UNFPA has been working with the
government and relevant parterns to raise awareness of obstetric fistula.
b) Providing free treatment: It has been providing free treatment and
surgeries to women suffering from OF in selected fistula treatment and
referral sites in Nepal.
c) Strengthing the capacity of service providers: UNFPA is supporting
the capacity building of service providers through various workshops,
training and hands on practicum through national and international
experts.
04/12/2021 12
13. 3. Training site development.
a) BPKIHS has been developed as an obstetric fistula training site by the
National Health Training Center with UNFPA support.
b) In partnership with JPHIEGO, UNFPA has supported the development of
an on-the-job competency-based surgical training manual on obstetric
fistula.
04/12/2021 13
14. 4. The Rural Ultrasound Programme: It aims for the timely
identification of pregnant women with risks of obstetric complication to
refer to comprehensive emergency obstetric and neonatal care (CEONC)
centres.
5. Management of pelvic organ prolapse and Obstetric Fistula:
Under Reproductive health morbidity prevention and management
programme, Each year the government allocates funds to manage POP and
OF including free screening, providing silicon ring pessaries, Kegel’s exercise
training and free surgical services at designated hospitals.
04/12/2021 14
15. Conclusion
Fistula does not occur in isolation. Therefore, its prevention and treatment
require an integrated and coordinated approach and collaboration.
04/12/2021 15
16. May 23rd,2020 Theme: “End gender inequality! End health inequalities! End Fistula now!”
04/12/2021 16
