LONDON (AlertNet) - Developing countries must ban child marriages as part of stepped up efforts to reduce horrific childbirth injuries that shatter lives, a report released by U.N. Secretary General Ban Ki-Moon says.
It estimates $750 million is needed over the next five years to treat new and existing cases of obstetric fistula, a devastating condition which causes chronic incontinence and often results in the girl or woman being thrown out of her community.
Obstetric fistula is a hole in the birth canal caused by prolonged labour when the baby is too big to pass through the pelvis or lying in the wrong position. The condition can affect any woman but is a particular risk for girls giving birth in adolescence when their pelvises are not fully formed.
In some cases a woman may be in agonising labour for a week or more. In most cases the baby is born dead.
"These women are the living reminder of high maternal mortality. They are the ones who survived an obstructed labour. Most die," said Gillian Slinger, coordinator of the Campaign to End Fistula.
The smell of constantly leaking urine and/or faeces often leads to the woman being shunned by her husband and ostracised by her community, and in some cases persecuted. Unable to work, she may have to resort to begging and in some cases, become severely malnourished.
"It's often assumed that it is a punishment because she has not been a good wife or a good woman. This means she is very stigmatised," added Slinger, a midwife who has seen many fistula cases during her work with Medecins Sans Frontieres.
"There's a big psychological impact. She's not only traumatised by the labour and the loss of her baby, in most cases she's also traumatised from being abandoned by her community."
The isolation and low self-esteem leads some women to commit suicide, the report says.
MIDWIVES KEY TO PREVENTION
Fistula can lead to ulcerations, infections, kidney disease and burns to the legs and vulva. Damage to nerves also leaves some women unable to walk.
Slinger said many women tried to stem the flow of urine by staying immobile and reducing their fluid intake, both of which caused a host of other medical problems.
The report calls for greater investment in training skilled midwives and birth attendants, setting up efficient referral systems and ensuring better access to emergency obstetric care, in particular Caesarian sections.
It also urges stronger measures to keep girls in school and stop child marriages - 16 million adolescent girls give birth each year, almost 95 percent of them in developing countries.
Fistula, which is almost unheard of in countries with widespread obstetric care, mostly affects poor women in remote areas of sub Saharan Africa and South Asia.
As many as 3.5 million women suffer from the condition with 50,000 to 100,000 new cases each year, according to estimates cited by the report released on Monday.
Slinger said most women could be treated at an average of around $300. But she said very few doctors were trained to carry out the often complex reconstructive surgery and most women could not afford it.
Given the backlog of cases, Slinger believed the $750 million figure quoted by the U.N. report for treating fistula was a conservative estimate
The Campaign to End Fistula was launched by the United Nations Population Fund and its partners with the aim of eliminating obstetric fistula by 2015 Â? the deadline for meeting the United Nations Millennium Development Goals (MDGs).
But the report says progress on MDG 5, which pledges to provide universal access to reproductive health, lags behind that made on all the other MDGs and attracts the lowest level of financial support.
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