Areas where prevention, treatment, and rehabilitation are currently taking place across the world.


Death by Childbirth: Obstetric Fistula
by Samantha Osaki

The first time I heard of obstetric fistulae was while reading Nicholas Kristoff’s famous book, Half the Sky. He introduces the topic in chapter 7, entitled “Why Do Women Die in Childbirth?” with a powerful narrative about a 24-year-old woman in Cameroon named Prudence who, through a convergence of many different factors, was fated to join the approximately 10 million women across the world who die in childbirth every year.

Prudence had been experiencing severe complications: her cervix was blocked, and her baby would not come out. She was laying in her family home in a village, cared for only by a traditional birth attendant who had had no formal medical training. Kristoff recounts that on Prudence’s third day of labor, “the birth attendant sat on Prudence’s stomach and jumped up and down,” effectively rupturing Prudence’s uterus. Even after the family located and finally convinced the nearest-residing doctor to operate (a full three days after Prudence was received at the hospital), the blood-loss and internal infection had proven to be too great. Prudence was brought back to her village to be left to die shortly thereafter.

In the United States and throughout the West, a woman experiencing obstructed labor is invariably given a cesarean (c-section) in a sterile hospital setting, enabling the child to be removed via an incision in the mother’s abdomen. As a result of this implementation in maternal care, obstetric fistula was largely eliminated in the States and throughout Western Europe by the early 20th century – and yet it remains arguably the most devastating and serious of all childbirth injuries for women in the developing world.

What is Obstetric Fistula?

According to the Fistula Foundation, a nonprofit organization dedicated to funding programs and building surgical clinics dedicated to eradicating fistula,

“After enduring days of agonizing, obstructed labor, a woman’s body is literally broken by childbirth…. All of that pushing creates a hole, or in medical terms a “fistula”, between the birth passage and an internal organ such as the bladder or rectum. A woman cannot hold her urine, and sometimes bowel content as well.

Her baby is unlikely to survive. If she survives, a woman with fistula is likely to be rejected by her husband because of her inability to bear more children and her foul smell. She will be shunned by her community and forced to live an isolated existence. These women suffer profound psychological trauma resulting from their utter loss of status and dignity, in addition to suffering constantly from their physical internal injury.”

For lack of a surgery that costs about $450 USD, approximately 30,000 – 50,000 women develop this childbirth injury, studies from this organization found. Among them, thousands are left untreated, subject to infection, and are forced to die. The Fistula Foundation goes on to state that the international capacity to treat fistula patients has been estimated at only around 14,000 women a year, leaving an enormous backlog of untreated patients.

What is Being Done?

The Fistula Foundation

The Fistula Foundation is the largest private charitable foundation supporting fistula treatment globally, with centers located in 19 countries across Africa and Asia. The organization is dedicated to raising awareness of and funding for fistula repair, prevention, and educational programs worldwide to help eradicate fistula, and it helps re-allocate resources to areas demonstrating greatest need. Find out more at:

Campaign to End Fistula

In 2003, the UNFPA and its partners launched a global Campaign to End Fistula in line with international targets to improve maternal health. In recent years, the Campaign has drawn the attention of policymakers, health officials, and entire communities to the issue of fistula. Last year, May 23rd, 2013, marked this organization’s launching of the first-ever International Day to End Obstetric Fistula. Find out more at:

Addis Ababa Fistula Hospital

Located in the capital of Ethiopia, the Addis Ababa Fistula Hospital has treated over 30,000 women with a success/cure rate of over 90% since it was first founded in 1975 by two gynecologists from New Zealand and Australia. Today, the hospital provides free fistula repair surgery to approximately 2,500 women every year and cares for 50 long-term patients. Find out more at:
treatment, prevention and rehabilitation in Niger. In February of 2012, it opened
Worldwide Fistula Fund

The WFF currently is focused on the obstetric fistula the Danja Fistula Center to provide treatment for 2,500 women within the first five years of operation. It also hosts prevention and rehabilitation programs to local women, as well as surgical training for local staff members. Find out more at:

In the end, what is most needed to alleviate maternal health problems like obstetric fistula is a drastic shift in public mindsets. Maternal deaths are not strictly a women’s issue but a matter of the human right to dignity, health and life itself.

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