[Vesicovaginal fistulas - birth complications which can lead to death. The risk of developing fistulas in Western Africa].

A vesicovaginal fistula develops when the blood supplying the tissues of the vagina and the bladder is cut off during prolonged obstructed labour. The tissues necrotize, and a hole forms through which urine passes uncontrollably. Women who develop fistulas are often abandoned by their husbands, rejected by their communities and forced to live an isolated existence. Fistula is called 'the single most dramatic aftermath of neglected childbirth'. In addition to complete incontinence, a fistula victim may develop nerve damage to the lower extremities after a multi-day labour in a squatting position. Fistula victims also suffer profound psychological trauma resulting from their utter loss of status and dignity. Severe social isolation is a result of the incontinence. Poverty, long distances and long waiting lists deter women from travelling to major health centres.