NAIROBI, 14 June 2007 (IRIN) - Poverty, inadequate investment in healthcare services, lack of knowledge about maternal health and pregnancy-related emergencies are some of the limitations aggravating the problem of obstetric fistula in Tanzania, according to a new report.

Obstetric fistula is a hole that forms between the bladder and vagina or between the rectum and vagina during prolonged and obstructed childbirth. The constant pressure of the foetal skull against the soft tissue around the vagina and bladder or rectum cuts off the blood supply to the tissue, causing it to disintegrate. Urine or faeces leak continuously through the resulting hole and from the vagina. In nearly all cases of obstetric fistula, the baby dies, according to the report.

About two million girls and women are estimated to be living with fistula worldwide, and the problem remains one of the most neglected issues in women's health and rights.

The 12 June report, Risk and Resilience: Obstetric Fistula in Tanzania, by the NGO EngenderHealth and the Tanzanian Women's Dignity Project, showed that antenatal care services, while widely available in the east African country, were inconsistent and inadequate.

According to the study, which was carried out in three Tanzanian districts - Singida Rural, Songea Rural and Ukerewe - in 2006, lack of birth preparedness, including basic information on childbirth and corrective action, put more women at risk of developing obstetric fistula.

The survey, which was based on the case studies of 61 girls and women living with fistula, as well as their families, community members and healthcare providers, revealed that lack of access to emergency caesareans posed a great threat to women's lives.

"For girls and women in the study, the most commonly cited barriers to facility-based delivery were that they lacked money and that the hospital was too far away," it said. "The second most commonly reported delay was 'delay in transportation'. The barriers are critical reasons why women who need skilled assistance at delivery do not get the care they need; poor women in rural areas are likely to be disproportionately affected by the barriers."

The report also cited the cost and inaccessibility of high-quality fistula repair services as a constraint on the care for patients, and appealed for such services to be provided at no cost or else highly subsidised.

Most women with fistula had support from others, but the emotional and economic effects of the condition were substantial for the woman and her family, mainly because of the stigma attached and the additional resources needed for her care.

jn/mw

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