Created for the Global CHE Network
WOMEN’S HEALTH: OBSTETRIC FISTULA
Date: 2/11
(1 HOUR)
OBJECTIVES:
After working through this lesson, participants will be able to:
1. Describe an obstetric fistula.
2. Know the main cause of obstetric fistula.
3. Explain some problems caused by obstetric fistula.
4. List three ways to prevent obstetric fistula, and one way to treat them.
5. Identify female reproductive organs in a drawing.
OVERVIEW FOR TRAINERS: This is a lesson in the series on women’s health. Teach this lesson
alongside the health stories, A walk to health and Terefa’s story. Read this lesson through before
teaching it. Many people may not be familiar with the section on Female Anatomy. Teach this lesson
with sensitivity to your culture. You may want to teach men and women separately.
METHOD
I.
TIME
Living in shame
Divide into small groups to read
and discuss the story, Living in
shame. Return to the large group
to discuss them further. Make a
list of any terms that are new or
unclear to you.
B.
What is the cause of their
shame and suffering?
C.
What is an obstetric fistula?
Explain these terms:
vagina, bladder, rectum,
obstetric, fistula
30”
KNOWLEDGE
I.
Living in shame
A. Describe the living conditions of
these young women and girls.
1. Shame
2. Isolation
3. Abandoned by husbands
4. Isolate from others
5. Poverty—unable to earn
money
6. Despair
7. Blamed or shunned by others
B. What is the cause of their shame
and suffering?
1. They are living with an
obstetric fistula.
2. t Their babies probably also
died.
C. What is an obstetric fistula?
1. An obstetric fistula is a hole
between her vagina and her
bladder or rectum.
2. Obstetric means occurring
during childbirth, during the
birth of the baby.
3. A fistula is an opening or hole.
4. The vagina is the birth canal.
5. The bladder is where the urine
or pee is stored.
6. The rectum is the end of the
intestines or gut where the
feces or poop is stored.
7. A hole between the bladder
and the vagina causes urine or
pee to leak out the vagina
8. A hole between the vagina and
the rectum causes feces or
This lesson is part of an extensive series for use in Community Health Evangelism (CHE) ministries. CHE facilitators
skilled in participatory learning methods enable communities to escape cycles of poverty and live as followers of
Jesus.
2
WOMEN’S HEALTH: OBSTETRIC FISTULA
METHOD
II.
TIME
KNOWLEDGE
D.
What causes obstetric
fistula?
D.
E.
Why are these women
embarrassed or ashamed?
E.
F.
What other problems can
result from the obstetric
fistula?
F.
G.
We will discuss prevention
and treatment of obstetric
fistula in a few minutes.
G.
Cause of obstetric fistula
A. Divide into small groups, or
work as a large group.
What do the ovaries,
Fallopian tubes, uterus and
vagina do?
B.
Find the bladder, uterus,
vagina, rectum, and
backbone.
C.
What cause an obstetric
fistula?
20”
II.
poop to leak out the vagina.
What causes obstetric fistula?
1. An obstetric fistula is a
complication of childbirth.
2. Obstetric fistulas often occur
when there is a long or
blocked labor.
3. We will talk more about this
later.
Why are these women
embarrassed or ashamed?
1. Usually, their baby died during
the delivered.
2. Now, they have leakage or
urine or feces (pee or poop).
3. That is smelly and
embarrassing.
What other problems can result
from the obstetric fistula?
1. Obstetrical fistula can result in
other problems or medical
complications.
2. They may have infections.
3. They may be infertile, or have
difficulty getting pregnant.
4. It may be difficult or painful to
have sex.
5. Some women are paralyzed or
have difficulty walking.
Prevention and treatment
Cause of obstetric fistula
A. What do they do?
1. The ovaries produce eggs.
2. An egg travels through the
Fallopian tubes to the uterus
or womb.
3. An egg is fertilized by a sperm
in the uterus.
4. The unborn baby grows in the
uterus or womb.
5. During childbirth, the baby
passes through the vagina or
birth canal.
B. Find the bladder, uterus, vagina,
rectum, and backbone.
1. The bladder is the sac that
holds the urine.
2. The uterus is the womb.
3. The vagina is the birth canal.
4. The rectum is the end of the
intestines or gut.
5. The backbone is the spine.
C. What causes an obstetric fistula?
1. During childbirth, the baby
3
WOMEN’S HEALTH: OBSTETRIC FISTULA
METHOD
D
E.
III.
TIME
Are there any other causes
of obstetric fistula?
Explain if needed: Female
genital mutilation is a rite of
some cultures removing
part of the women’s sex
organs.
Who is at risk for obstetric
fistula?
Prevention and treatment
Hand out Facts on obstetric
fistula. Discuss in large group.
A. Why this a major problem?
B.
KNOWLEDGE
How can obstetric fistula be
prevented?
D.
E.
III.
passes through the vagina or
birth canal.
2. If there is a blockage, the labor
may last for several days.
3. The baby’s head puts pressure
on the walls of the vagina.
4. That reduces the blood supply
to the area.
5. If childbirth is long and difficult,
or blocked, the walls of the
vagina become thin and
damaged.
6. Over time, the baby often dies.
7. The damaged wall of the birth
canal leaves a hole, or fistula,
between the vagina and the
bladder or rectum.
Other causes
1. Harmful traditional practices
2. Female genital mutilation or
female circumcision
3. Harmful cutting of the vagina
during childbirth
4. Rape or sexual abuse
Who is at risk?
1. Young women
2. Women with poverty and few
resources
3. Early marriage and childbirth
4. Low education
5. Poor nutrition
6. Women with a small pelvis, so
the baby’s head cannot pass
out. (Teenage mothers have
small pelvises.)
7. Low status of women, so they
do not get adequate care
8. Women who do not have
access to good health care or
prenatal care
9. No access to emergency C
sections
10. Women living in Asia and in
sub-Saharan Africa
Prevention and treatment
A.
B.
Major problem
1. Many women are involved.
2. More than 2 million women
may have obstetric fistula.
3. They live in shame, isolation,
and poverty, with medical
problems.
Prevention
1. Delay marriage and childbirth.
4
WOMEN’S HEALTH: OBSTETRIC FISTULA
METHOD
TIME
KNOWLEDGE
This allows time for the girl’s
pelvis to grow.
3. Young women with a small
pelvis often have difficult
deliveries and obstetric fistula.
4. Avoid traditional practices
such as female genital
mutilation and cutting of the
vagina during the delivery.
5. Get good prenatal care, or
health care before the birth of
the baby.
6. Get good delivery care.
7. Have access to emergency
medical care, such as
emergency C sections.
Treatment or cure
1. Most obstetric fistula can be
cured with a relatively simple
surgery.
2. The hole in the vagina and in
the bladder or rectum is
repaired.
3. This prevents the leakage of
urine and feces (pee and
poop).
4. The lives of the women
improve dramatically after
surgery.
2.
C.
How can obstetric fistula be
cured?
C.
References:
Hamlin Fistula. 2010. Treatment, prevention and raising awareness of obstetric fistula. Available from:
http://www.hamlinfistula.org.au/hospital/regionalcentres.html
USAID. 2010. Ethiopia. Available from: http://fistulacare.org/pages/sites/ethiopia.php
Wikipedia. 2011. Obstetric fistula. Available from: http://en.wikipedia.org/wiki/Obstetric_fistula
Wilson, B. 2007. Hospital gives Ethiopian women a chance at care. Available from:
http://www.npr.org/templates/story/story.php?storyId=6907000
World Health Organization. 2006. Obstetric fistula. Available from:
http://whqlibdoc.who.int/publications/2006/9241593679_eng.pdf
World Health Organization. 2010. 10 Facts on obstetric fistula. Available from:
http://www.who.int/features/factfiles/obstetric_fistula/en/
ATTITUDE:
SKILL:
EVALUATION:
MATERIALS:
.
Obstetric fistula can be prevented and cured.
Participants will be able to teach others about obstetric fistula.
Are the participants teaching their neighbors about obstetric fistula?
-Newsprint, markers, masking tape
-Living in shame story
-Facts on obstetric fistula handout
This lesson is used in: Health Promotion and in Women’s cycle of life/Women’s health
5
Living in Shame
Millions of girls and young women in resource-poor countries are living in shame and
isolation, often abandoned by their husbands and excluded by their families and communities.
They usually live in abject poverty, shunned or blamed by society and, unable to earn money,
many fall deeper into poverty and further despair.
The reason for this suffering is that these young girls or women are living with an obstetric
fistula due to complications which arose during childbirth. Their babies are also probably
dead, which adds to their depression, pain and suffering.
An obstetric fistula is an abnormal opening or hole between a woman’s vagina and bladder
and/or rectum, through which her urine and/or feces continually leak. Naturally these women
are embarrassed that they are unable to control their bodily functions, that they are constantly
soiled and wet, and that they smell. Their pain and shame may be further complicated by
recurring infections, infertility, and damage to their vaginal tissue that makes sexual activity
impossible and paralysis of the muscles in their lower legs which may require the use of
crutches, if any are available.
The greater tragedy is that these obstetric fistulas can largely be avoided by delaying the age
of first pregnancy, by stopping harmful traditional practices and by timely access to maternal
and obstetric care. They can be repaired by simple surgery.
Adapted from: World Health Organization. 2006. Obstetric fistula.
Available from: http://whqlibdoc.who.int/publications/2006/9241593679_eng.pdf
Discussion questions:
Discuss these questions in your small group. Return to the large group to discuss them further. Make
a list of any terms that are new or unclear to you.
1. Describe the living conditions of these young women and girls.
2. What is the cause of their shame and suffering?
3. What is an obstetric fistula?
4. Explain these terms: vagina, bladder, rectum, obstetric, fistula
5. What causes obstetric fistula?
6. Why are these women embarrassed or ashamed?
7. What other problems can result from the obstetric fistula?
8. Can obstetric fistula be prevented? How?
9. How can obstetric fistula be treated?
Practice
Practice telling each other the story of Living in shame.
6
Female Anatomy
This is a picture of a
woman’s reproductive
organs, looking from the
front.
Source of illustrations: Wikimedia, 2011
This is a cross-section,
looking at a woman’s
internal organs from the
side.
Find the:
1. Bladder (where the
urine or pee is stored)
2. Uterus or womb
3. Vagina or birth canal
4. Rectum (the lower
end of the intestines
or bowel). The rectum
contains feces or
poop.
5. Backbone
7
Facts on Obstetric Fistula
Each year between 50 000 to 100 000 women worldwide are affected by obstetric fistula, a
hole in the birth canal. The development of obstetric fistula is directly linked to obstructed
labor.
Women who experience obstetric fistula suffer constant incontinence, shame, social
segregation and health problems. It is estimated that more than 2 million young women live
with untreated obstetric fistula in Asia and sub-Saharan Africa.
Obstetric fistula is preventable; it can largely be avoided by:



delaying the age of first pregnancy;
stopping harmful traditional practices; and
timely access to obstetric care.
Most fistula occur among women living in poverty in cultures where a woman’s status and
self-esteem may depend almost entirely on her marriage and ability to bear children.
Patients with uncomplicated fistulae can undergo a simple surgery to repair the hole in their
bladder or rectum.
Preventing and managing obstetric fistula will contribute to improved health of mothers.
Adapted from: World Health Organization. 2010. 10 Facts on obstetric fistula. Available from:
http://www.who.int/features/factfiles/obstetric_fistula/en/