Obstetric fistula is a devastating, yet entirely preventable and treatable childbirth injury that continues to affect hundreds of thousands of women and girls around the world. It is a stark symptom of inequality - rooted in poverty, worsened by limited access to maternal health care, and perpetuated by harmful practices such as child marriage and female genital mutilation.
Today, an estimated 500,000 women and girls live with obstetric fistula across 55 countries, with the highest burden in sub-Saharan Africa. With timely access to quality maternal health services and surgical repair, fistula can be prevented and treated.
Obstetric fistula occurs after a long or obstructed childbirth. The pressure from a baby’s head against the mother’s pelvis cuts off blood supply, causing tissue to die and fall away; the hole left is called a fistula. Aside from its deep damage to the body, obstetric fistula is also a traumatic event that affects women’s autonomy and self-esteem.
Fistula surgery is highly effective and relatively low-cost, with a success rate that can reach as high as 95 per cent and most women can regain their full, healthy lives after treatment. Yet when we weigh these affordable solutions against the devastating consequences of untreated fistula, one question remains: Why does this condition still persist? The answer lies in deeper systemic barriers such as gender inequality, poverty, lack of education, and gaps in healthcare access. The good news? These challenges are solvable. Here are three key ways we can eliminate obstetric fistula for good:
1. Children not mothers
Young women and girls who are subjected to early marriage are more prone to develop obstetric fistula because of several factors. Childbearing before the pelvis is fully developed as well as malnutrition, small stature, and generally poor health conditions, are contributing factors to obstructed labour.
Issues such as child marriage, female genital mutilation, early unintended pregnancies and unmet needs for sexual and reproductive health services, including contraception, need to be addressed.
2. More midwives, less problems
With quality sexual and reproductive health care services and skilled professionals, obstetric fistula can stop being an issue and midwives can deliver 90 per cent of all essential sexual, reproductive, maternal and newborn health services
A midwifery model of care is a key part of the solution, bringing care and attention to even remote communities, improving access to services that are culturally acceptable, encouraging better utilization.
3. Agency, equality and access
Obstetric fistula isn’t just a medical issue, it’s a justice issue. Too many women and girls lack the power to make decisions about their own bodies, health, and futures. Gender inequality strips them of autonomy, leaving them vulnerable to early pregnancies, unsafe deliveries, and harmful practices like female genital mutilation (FGM), which can increase the risk of complications during childbirth.
Here’s how change happens:
- Agency: Women and girls must have the right to decide if, when, and with whom to have children. This means access to education, contraception, and the elimination of harmful practices like child marriage.
- Equality: Ending discriminatory norms that affect women and girls’ personal development and growth. When girls stay in school and women can participate equally in society, they’re more likely to have safer pregnancies.
- Access: All women should have access to medical care, no matter their income or where they live. Investing in local maternal health services and trained midwives ensures help is available when it’s needed most.
