Tragically, there is a strong association between fistula and stillbirth, with research indicating that approximately 90 per cent of women who develop obstetric fistula end up delivering a stillborn baby.

Obstetric fistula has been virtually eliminated in industrialized countries through the availability of timely, high-quality medical treatment for prolonged and obstructed labour – namely, Caesarean section. Obstetric fistula occurs mostly among the poorest and most marginalized women and girls, especially those living far from medical services and those for whom services are not accessible, affordable or acceptable. Childbearing in adolescent girls before the pelvis is fully developed, as well as twin pregnancy, breech position of the baby, malnutrition, small stature and generally poor health conditions are among the physiological factors contributing to obstructed labour. However, any woman may experience obstructed labour, including older women who have already had babies.

Obstetric fistula is associated with devastating lifelong morbidity with severe medical, social, psychological and economic consequences.

Left untreated, obstetric fistula causes chronic incontinence and can lead to a range of other physical ailments including frequent infections, kidney disease, painful sores and infertility. The physical injuries combined with misperceptions about the cause of fistula often result in stigma and discrimination, leading to social isolation, psychological harm and mental health issues. Women and girls with fistula are often unable to work, and many are abandoned by husbands and families and ostracized by their communities, driving them further into poverty and vulnerability and decreasing their quality of life.

The continued occurrence of obstetric fistula is a human rights violation, reflecting the marginalization of those affected and the failure of health systems to meet their needs. Their isolation means they often go unnoticed by policymakers, and little action is taken to address or prevent their condition. As a result, women and girls suffer needlessly, often for years, with no hope in sight.

Reconstructive surgery can usually repair a fistula. Unfortunately, the women and girls affected by this injury often do not know that treatment is possible, cannot afford it or cannot reach the facilities where it is available. There is also a shortage of highly trained and skilled surgeons to perform the repairs. Tragically, at the current rate of progress, many women and girls living with fistula today could die before ever being treated.

Beyond surgery, a holistic approach that addresses the psychosocial and socioeconomic needs of fistula survivors is required to ensure full recovery and healing.

Counselling and other forms of support – such as livelihood skills, literacy, job training and health education – may also be necessary to help women reintegrate into their communities, rebuild their lives, and regain their dignity and hope after surviving fistula.

Follow-up is also crucial for all women and girls who have had fistula repair surgery, helping to ensure they do not develop the injury again during subsequent births and to protect the survival and health of both mother and baby. Women and girls who have been deemed inoperable or incurable also require special and sustained attention and support.

Prevention is the key to ending fistula. Fistula is an indicator of poor quality of care. Ensuring skilled birth care at all births and providing timely and high quality emergency obstetric care for all women and girls who develop complications during delivery would make this tragic condition as rare in developing countries as it is in the industrialized world.

Additionally, providing family planning to those who want it could significantly reduce maternal disability and death.