The State of Urogynecology in Bangladesh

In Bangladesh, the prevalence of PFDs is quite significant. According to a nationwide survey in 2016, the national prevalence of obstetric fistula is 0.42 per 1,000 women with at least one birth, with an estimated number of cases 19,755 (1). The same study shows the national prevalence of POP 12 per 1,000 women with at least one birth with an estimated number of POP cases of 535,263. The prevalence of perineal tear was not estimated, but about 51-61% of women having fistula or POP had some degree of perineal tear. From the statistics of different facilities, it is shown that the overall situation has not changed much. Another study shows a prevalence of UI in 23.7% among women 30-59 years of age (2). The reason behind such a massive burden of PFDs can be attributed to factors like lack of quality obstetric care, early marriage, frequent childbirth, high rate of home delivery, lack of education and awareness, etc. Women suffer silently because many are unaware of the availability of treatment, and many can’t afford it. Patients suffering from obstetric fistula hide themselves due to the fear of stigmatization. For the past few years, a rising trend of iatrogenic fistula has been observed. This rate of rise is alarming, constituting more than 40% of repaired cases annually (3). This represents the lack of adequate training of gynecologists, and some non-trained non-gynecologists are doing gynecological surgeries, which is an ethical issue in medical practice.

Though PFDs constitute a significant burden on women’s health, they still fails to gain priority in the practical field. There is no separate department of Urogynecology in any of the medical college hospitals except

Dhaka Medical College, where a Urogynaecology department has been started very recently. PFDs are managed mainly by general gynecologists having no or minimum training in Urogynaecology. Though recently, some posts of Professor/Associate/Assistant professor in Urogynaecology have been created in different public medical colleges, there is a lack of separate clinical/academic staff or logistics, and it is not yet possible to establish separate departments there. Over the past decade, repeated attempts were initiated by the leading gynecologists of the country to start a Fellowship program on Urogynaecology under “Bangladesh College of Physicians & Surgeons (BCPS)” the largest body of postgraduate medical degrees in Bangladesh. But repeatedly, the proposal was declined due to the strong opposition from some related surgical faculties. Ultimately after years of struggle, the council passed the decision to start a fellowship program with the name of “Female Pelvic Medicine and Reconstructive Surgery”. This program will officially start in January 2024, and for this, Dhaka Medical College & Hospital has been recognized to run the training program.

Since 2012, the institute, established solely to serve the underprivileged women of society suffering from urogynecological problems in Bangladesh, has been named “MAMM’S Institute of Fistula and Women’s Health (MIFWOH).” This is a private hospital that provides treatment for all sorts of PFDs to women of underprivileged society at free of cost. This hospital also provides training to gynecologists who are interested in this field. Considering the importance of the subject, a society named “Female Pelvic Medicine & Reconstructive Surgery Society of Bangladesh (FPM-RSSB) was formed last year.

Urogynecology in Bangladesh is still in its very preliminary state. It needs to be patronized and prioritized by government and private initiatives. Local fellowship programs must be strengthened, and training should be enhanced by engaging local and foreign experts. There should be adequate resource allocation for running separate departments in tertiary care hospitals to ensure good services. It is vital to improve urogynecology in Bangladesh to improve women’s quality of life.

References:

• National Institute of Population Research and Training (NIPORT), MEASURE Evaluation, icddr,b. Bangladesh Maternal Mortality and Health Care Survey 2016.
• Islam RM, Bell RJ, Hossain MB, Davis SR. Bangladesh midlife women's health study (BMWHS): methods, challenges, and Maturitas. 2015 Jan 1;80(1):89-94.
• UNFPA Bangladesh. Annual report on obstetric fistula 2021 [Internet]. 2022 [cited 2023 Sept 16]. Available from: https://bangladesh.unfpa.org/en/publications/annual-report-obstetric-fistula- 2021