how to help women in poor countries without over-medicalizing?

[meowee]

I have long been troubled by the plight of women with fistulas in impoverished countries... I was just wondering, what do you is the best way to tackle this problem in 3rd world areas? Make c-sections more readily available? How could this be done without over-medicalizing? Should there be prenatal care clinics set up, or is that too, over-medicalizing? And many of the prolonged labors that lead to fistulas are caused in the first place by malnutrition. So should nutrition be the focus?

Does anyone have thoughts on this?

[Kitten]

I think plain old good nutrition would solve a lot of problems, and not just for pregnant women. It would save more lives than dumping expired/recalled vaxes on them. But that's a whole 'nother story.....

[cappuccinosmom]

NPR did a report on fistulas in Ethiopia (my dh's country), and while they summarized the problem as "too many babies": , the actual content of the report indicated child marriages and severe malnutrition combined with a lifestyle that included lots of heavy carrying/lifting from early childhood on were the root problems (and I believe those to be so true. when we were there, the heaviest loads we saw carried were either by donkeys or women. You'd see a little old lady bend double with a load of firewood as her full-grown son walked ahead of her carrying a little market bag, if anything at all : ). There are major cultural changes that have to happen along with better nutrition.

[Crisstiana]

There's an interesting article in MedScape Today, "Etiologies of Vesicovaginal and Rectovaginal Fistulas," that lays out the main causes ("etiologies") of fistulas and seems to be a summary of a number of recent studies about the problem in developing countries.

It seems like the main problem is due to obstructed labor (the article linked above says that it causes 90% of such fistulas, and I've seen that figure reported elsewhere). In turn, the article says that obstructed labor in developing countries is more common in women who have had many children, are between the ages of 10 (yikes) and 19 years of age, and are malnourished.

Making the jump from identifying the causes to taking steps to prevent the problem seems huge. Better nutrition, delayed sexual activity, and c-sections when warranted would be ideal, but I have no idea how to get there. I'm glad, however, that more attention is being drawn to this and other medical problems of birthing women in developing countries. Hopefully, addressing such issues will become more of a priority in their countries and internationally.

[NatureMama3]

not to mention the problem of FGM which also contributes to fistulas.

[cfiddlinmama]

NatureMama - I was just coming to post that it is probably caused by FGM in a large percent of cases. Contributing to or causing "obstructed labor" as mentioned in the article above. :

[cappuccinosmom]

But not all FGM involves sewing parts together--I can totally see the extreme forms obstructing labor, but how would the milder forms that simply involve cutting obstruct labor?

[cfiddlinmama]

I'm not sure what you mean by "simply involves cutting." Clitoral hood removal probably wouldn't effect labor. Labial removal I'm guessing could cause some serious scarring which would probably make for less stretching - more severe tearing. Someone much more knowledgeable than me could clarify this. There was just a thread in Birth Professionals about fistulas and FGM.

[mwherbs]

all forms have been shown to be associated with complications- and complication in childbirth-- here is a fairly good bit of info on wikipedia-- way down the page is the info risks/relating to childbirth (but they admit to not being able to study it well because of social difficulties)

http://en.wikipedia.org/wiki/Female_genital_cutting
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there are some outreach organizations that may be more helpful than others- I know a couple CPMs who have gone to several places and may be better ways to support care in 3rd world places-- although funding peace- is probably a big step anywhere

[Corriander]

What's also lacking in underdeveloped countries is enough trained birth attendants. many women and girls labor unattended or attended by untrained family members.