Obstetric Fistula

last updated June 2008

Obstetric fistula is an abnormal hole between a woman’s vagina and her bladder or rectum, which causes chronic incontinence. The most common cause of obstetric fistula is prolonged labor, which occurs more frequently in girls who have married and become pregnant in their teens than in older mothers, especially since girls subjected to early marriage are often poor, underdeveloped, and undernourished. The condition is most prevalent in sub-Saharan Africa and South Asia. In developed countries, problems during labor can be anticipated and skilled attendants can prevent fistula, but the vast majority of women affected by fistula in less developed countries have not received adequate medical care during childbirth. Smaller numbers of women develop fistula as a result of sexual assault or harmful traditional practices like female genital mutilation and cutting of the vagina during labor.

Fistula is a treatable condition, and success rates for reconstructive surgery are very high; some sources say that over 90% of women can be cured by a single operation. Unfortunately, many women cannot gain access to medical help. Of the estimated 100,000 new cases of obstetric fistula each year, only about 6,500 are treated. Many women do not know that treatment is available or cannot afford to pay for it. In other cases, husbands, brothers or other family members charged with making medical decisions on behalf of women fail to seek medical assistance for them, both during childbirth and after they have become afflicted with obstetric fistulae. Girls forced into early marriage, already the victims of a human rights abuse, are thus further victimized by being denied control over their families’ resources and decisions about their health. Some men prefer to find another wife rather than seek treatment for a wife who is suffering and unable to bear children.

An untreated fistula condemns the woman who suffers from it to a lifetime of pain and leaking urine and/or feces from her vagina. This uncontrollable condition leads women to be ostracized from their communities. Limited studies in India and Pakistan suggested that 70-90% of women with fistula had been abandoned or divorced, and one in every five women at the Addis Ababa Fistula Hospital reported having to beg for food to survive. The shame, humiliation, and despair resulting from social isolation drive some women to depression and even suicide. In addition to emotional harm, women affected by fistula often face serious physical consequences, including recurring infections, paralysis of lower leg muscles, amenorrhea, infertility, frequent ulcerations, kidney disease, and even premature death.

Although there are many causes of obstetric fistula, and it is closely connected to the larger problems of poverty and inadequate health care, many prevention strategies are aimed at encouraging later marriage and delayed pregnancy, often by empowering women to make their own choices about their reproductive lives.

Compiled from:

Rebecca Coombes, “Supporting Surgery for Obstetric Fistula,” BMJ: Helping Doctors Make Better Decisions, 13 November 2004.

Obstetric Fistula: Ending the Silence, Easing the Suffering,” The Information & Knowledge for Optimal Health (INFO) Project, INFO Reports Issue No. 2, September 2004.

Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development,” World Health Organization, Department of Making Pregnancy Safer, 2006.

Campaign to End Fistula, United Nations Population Fund, last accessed 11 June 2008.