Female Genital Fistula: Changing Etiologic Landscape and Policy Implications for Bangladesh

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: A 2003 situation analysis of female genital fistula in Bangladesh estimated a case load of 71000 – 100, 000 for the population of 160 million people. Historically, obstructed labor has been the predominant cause of fistula, and all such cases have been term ‘obstetric fistula’. Obstetric and gynecologic services have expanded significantly in recent years and seem to have added a new dimension in fistula causation, with an increasingly more prominent role for iatrogenic cases. Fistula Care plus, a project implemented by EngenderHealth, with funding support from USAID, seeks to understand and to meet the challenge of providing holistic fistula care services – including prevention – in this changing landscape.

Methodology: We analyzed retrospective data of 450 women who had fistula repair surgery in Bangladesh in the sites supported by Fistula Care Plus project and by the government of Bangladesh during January 2012 to December 2014. Selected variables from the patient data were analyzed using SPSS.

Results: Just over half of the number of cases analyzed (56%), had a history of obstructed labor before onset of the leaking urine or stool or both. Twenty one percent of the cases had a history of obstetric surgery, and 23% had history of gynecological operations before the fistula symptom started. The commonest gynecological operations were elective vaginal or abdominal hysterectomy.

Conclusion: Urine leakage after elective gynecological procedures is almost exclusively from surgical trauma. Leakage after obstetric procedure could be either from surgical trauma or from obstructed labor. Conceptually, the rapid increase in obstetric/gynecologic surgery is changing the landscape of female genital fistula in Bangladesh. A thorough understanding of the problem will help in developing preventive interventions. In this connection new policies are being adopted for prevention of female genital fistula on which the government and Obstetrics/Gynecology professional bodies have started working.