Home Institution

Harvard University

Publication Date

Spring 2008

Program Name

Mali: Gender, Health, and Development


Obstetric fistula is arguably the most devastating result of childbirth complications, aside from maternal and neonatal mortality, the latter of which almost always occurs during deliveries which result in fistula. Defined as a hole in the birth canal, obstetric fistula is generally caused by prolonged obstructed labor in the absence of prompt medical intervention.20 This injury results in chronic incontinence through the vagina as well as many other secondary health consequences.33 Additionally, it is impossible to measure the extensive social and psychological burdens suffered by women because of this affliction. Despite the fact that obstetric fistula is both preventable and treatable (it has been eliminated in the Europe and North America)33, it is estimated that two million women world wide are living with this condition and that up to 100,000 new cases develop each year.2 These figures are almost certainly underestimates of the magnitude of the true problem, as they are based on the number of women who seek treatment, and cannot include all the potential patients who, likely because of the same reasons they were unable to medical care when they experienced delivery complications, are unable to reach these services. Some studies estimate that there are as many as 100,000 to one million fistula sufferers in Nigeria alone.2 Indeed, many of the known fistula cases can be found in Sub-Saharan Africa, with nearly the entirety of the injured population being women from this region along with Asia and the Middle East.33 Mali, the largest country in West Africa, bordered by seven other countries including Nigeria and completely landlocked, falls within this affected region.31 In addition, it is characterized by a very high maternal mortality rate, an indicator which is closely correlated with the occurrence of obstetric fistula; one can be certain that Mali is affected by this malady.18 And it is the community as a whole that is finally affected by fistulae. In addition to the physical, emotional and psychological pain of the women who develop this injury, which comes after the trial of childbirth and usually the loss of a child, and is followed by shame and ostracism, this is an injury that affects husbands, families and communities. Society is affected by the condition of its mothers and the health of mothers reflects the health of the country. In the words of Professor Kalilou Ouattara, head of the Urology Department at Point G Hospital in the capital city of Bamako, “The existence of fistula is the barometer of maternal health in the country. If year by year fistula decreases, we know that maternal heath is improving.”21 It is a well established fact that obstetric fistula is generally experienced by the most marginalized members of a population: impoverished, illiterate, young women from remote areas.33 Fistulas are important not just in recognizance of the impact they have on those afflicted but also because of what they can tell us about the health of a community and how a society takes care of its most vulnerable members. It is for these reasons that I chose to study obstetric fistula in Mali. I based my research on the goal of understanding how the malady exists within this unique context.


Obstetrics and Gynecology


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