By Michaela Maynard, Global Health Issue Analyst

For each minute that it takes you to read this post, a woman is dying in labor, and for every birthing death, twenty more women are left suffering from disability. Obstetric fistula is the most devastating of all pregnancy-related disabilities. Worldwide, the condition affects over two million women. Obstetric fistula results from prolonged, obstructed labor without access to timely medical care, typically a caesarean section.  During prolonged labor, the positioning of the baby and the pressure of the infant’s head can result in damage to the organs of a women’s pelvis. In almost 90% of fistula cases the infant is stillborn or dies within the first week of birth and if the mother survives, she may be left with a fistula or hole between the vagina and the bladder or the vagina and the rectum, causing her to constantly leak urine or feces.

Women suffering from fistula are incapable of carrying out their normal workload, and they rely heavily on others for support.  In many instances, women report being divorced from their husbands, ostracized from their families, and forced out of their communities as a result of fistula. The constant leaking of urine and the smell that follows them is stigmatizing; they become outcasts and are pushed deeper into poverty and destitution.

Obstetric fistula is not a third-world anomaly. For centuries, women all over the world have been faced with prolonged, obstructed labor and obstetric fistula. In fact, the first fistula hospital was located in New York City on the site of what is now the Waldorf-Astoria Hotel. In the U.S., the availability of timely obstetric care has helped to eradicate fistula, yet women in Africa, South Asia, and other developing countries of the world still suffer from this preventable and treatable condition.

Surgery can treat the fistula, but the cost of surgical treatment and the lack of trained surgeons prevent women from receiving care. In countries of civil unrest, healthcare services are often depleted, roadways accessible to hospitals and clinics are destroyed, and women are physically, sexually, and psychologically abused. Fistula is rarely discussed and many afflicted women feel alone in their suffering.

Programs implemented to achieve Millennium Development Goal (MDG) five, aimed at reducing maternal mortality and achieving universal access to reproductive health, are helping to prevent obstetric fistula. Family planning, skilled birth attendants and emergency obstetric care are important for reducing fistula. Unfortunately, ten years into the 2015 deadline, we are still far from achieving MDG five.

Although systematic approaches to improving health care and increasing access to reproductive health services are vital components, these will not solve the problem completely. The complexities surrounding obstetric fistula are rooted in social, cultural and biological factors. Family and cultural traditions, such as early marriage and female genital mutilation, can lead to pregnancy at an early age, obstructed labor, and injury. Compared to their male counterparts, women are more likely to be malnourished, and malnutrition leads to pelvic underdevelopment, thereby putting women at greater risk for prolonged, obstructed labor. Often, women maintain lower socioeconomic status and play limited roles in society; these factors are exacerbated by illiteracy and the lack of a formal education, restricting women’s autonomy and their ability to make well-informed decisions about their reproductive health.

Inequalities in sexual and reproductive health will require a more complex solution. Although, increasing the number of trained skilled birth attendants is important, a skilled birth attendant won’t prevent prolonged, obstructed labor if the husband of the laboring women doesn’t allow his wife to be treated. Infrastructure changes in a local hospital may provide a safe, clean environment for a caesarean section, but if there are no trained surgeons to perform the operation, it will do no good; and if the woman has no transportation to the hospital, the problem will not be prevented.

I first learned about obstetric fistula three years ago, when I visited the Nkhoma Hospital in Malawi, Africa. Upon returning home, I wanted to tell everyone about obstetric fistula. I was shocked and outraged that women were suffering from this condition. So now, I make it a point to tell people about it– family, friends, coworkers, even congressmen on Capitol Hill. I remind people that this is happening to ordinary women- women just like your mother, wife, daughter or best friend. As an American woman, I am grateful that I will not have to suffer from this horrible condition, but just because it doesn’t happen in the U.S., doesn’t mean we should forget it exists.


Jones, Debra A (2007). Living Testimony Obstetric Fistula and Inequities in Maternal Health. (pp. 3-4).  Family Care International, United Nations Population Fund. Retrieved from,

Kristof, Nicholas D. (2003, May 16). Alone And Ashamed.  New York Times. Retrieved from

United Nations General Assembly. Supporting efforts to end obstetric fistula. Report of the Secretary-General. August 9, 2010.

United Nations Population Fund (2007).  Obstetric Fistula: A Tragic Failure to Deliver Maternal Care. Retrieved March 10, 2008, from

Zacharin, Robert F. (1988). Obstetric Fistula. Springer-Verlag Wien-New York. (pp 43).