Obstetric fistula is a hole in the birth canal caused by prolonged labour without prompt medical intervention, usually a Caesarean section. The woman is left with chronic incontinence and, in most cases, a stillborn baby.

The smell of leaking urine or faeces, or both, is constant and humiliating, often driving loved ones away. Left untreated, fistula can lead to chronic medical problems, including ulcerations, kidney disease, and nerve damage in the legs.

A simple surgery can normally repair the injury, with success rates as high as 90 per cent for experienced surgeons. The average cost of fistula treatment and post-operative care is just US $300. Sadly, most women with the condition do not know that treatment is available, or they cannot afford it.

Like maternal mortality, fistula is almost entirely preventable. But at least 2 million women in Africa, Asia and the Arab region are living with the condition, and some 50,000 to 100,000 new cases develop each year. The persistence of fistula is a signal that health systems are failing to meet the needs of women.

Obstetric fistula occurs disproportionately among impoverished girls and women, especially those living far from medical services. Affecting the most powerless members of society, it touches on nearly every aspect of UNFPA's mandate, including reproductive health and rights, gender equality, poverty and adolescent reproductive health.

In 2003, UNFPA spearheaded the global Campaign to End Fistula, a collaborative initiative to prevent fistula and restore the health and dignity of those living with its consequences.

Fast Facts

• Fistula used to be present in the U.S. and Europe, but was largely eliminated in the latter part of the 19th century and early 20th century with improved obstetric care in general and the use of c-sections in particular to relieve obstructed labor.

• The World Health Organization estimates that approximately 2 million women have untreated fistula and that approximately 100,000 women develop fistula each year.  Fistula is most prevalent in sub-Saharan Africa and Asia.

• In Ethiopia, alone, there are an estimated 100,000 women suffering with untreated fistula, and another 9,000 women who develop fistula each year.

• Less than 6 in 10 women in developing countries give birth with any trained professional, such as a midwife or a doctor.  In Ethiopia, only 1 in 10 women have a trained attendant.  When complications arise, as they do in approximately 15% of all births, there is no one available to treat the woman, leading to disabling injuries like fistula, and even death.

• The root causes of fistula are grinding poverty and the low status of women and girls.  In Ethiopia, the poverty and malnutrition in children contributes to the condition of stunting, where the girl skeleton, and therefore pelvis as well, do not fully mature.  This stunted condition can contribute to obstructed labor, and therefore fistula.

• But, fistula is both preventable and treatable.  The Addis Ababa Fistula Hospital has treated over 30,000 women over 33 years.  Their cure rate is over 90%.  Fistula can be prevented if laboring women are provided with adequate emergency obstetric care when complications arise.

For more frequently asked questions

For fistula links

"A Walk to Beautiful" is a feature length film about Fistula.  It follows five women in Ethiopia who suffer from devastating childbirth injuries, particularly, obstetric fistula.  Shunned by their communities, these women append their lives in loneliness and shame. The film follows them on their journey to the Fistula Hospital in Addis Ababa, Ethiopia, where their lives are transformed. The film weaves their stories into a portrait of grief and courage, compassion and triumph.  "A Walk to Beautiful" was named Best Feature Length Documentary of 2007 by the International Documentary Association.  The film was produced by Engel Entertainment in New York, and is 85 minutes long.

Director: Mary Olive Smith
Executive Producer: Steven Engel
Co-Director: Amy Bucher
Editor: Andrew Ford
Co-Producer: Allison Shigo

How to help:

Campaign to end fistula - www.endfistula.org

www.fistulafoundation.org