International Day to End Obstetric Fistula

 A. Major global initiatives  The implementation of the Programme of Action of the International Conference on Population and Development, adopted in 1994, contributes to the achievement of the 2030 Agenda for Sustainable Development. It is stated in the Programme that “the human rights of women and the girl child are an inalienable, integral and indivisible part of universal human rights”, as well as the right to attain the highest standard of sexual and reproductive health. It calls for the elimination of all practices that discriminate against women and the advancement of gender equality and equity and the empowerment of women. Achieving universal access to sexual and reproductive health care and fulfilling the reproductive rights of individuals remain an unmet goal, with millions left behind. In 2021, the High-level Commission for the 25-year review of the implementation of the Programme of Action assessed progress made with regard to 12 global commitments made at the 25-y...

According to an African proverb, “the sun should not rise or set twice on a labouring woman”. Unfortunately for an estimated half a million women and girls across sub-Saharan Africa, Asia, the Arab States region and Latin America and the Caribbean, childbirth lasted much longer than this proverb warns against – with devastating consequences. Prolonged, obstructed labour can lead to maternal death, stillbirth, and a severe injury called obstetric fistula. The condition causes incontinence and leaves women susceptible to both physical ailments like infection and infertility, as well as mental health issues driven by social stigma and ostracization. For twenty years, UNFPA has led the global Campaign to End Fistula , which aims to eliminate fistula by 2030 through prevention, treatment, social reintegration of survivors and advocacy programming.

A. Prevention strategies and interventions to achieve maternal and newborn health and eliminate obstetric fistula. The global Campaign to End Fistula , launched in 2003 by UNFPA and partners, focuses on four key strategies: prevention, treatment, social reintegration and advocacy. The Campaign is active in more than 55 countries and brings together nearly 100 partners with the aim of eradicating fistula globally. UNFPA leads the Campaign and serves as the secretariat of the International Obstetric Fistula Working Group, the main decision-making body of the Campaign. Since 2003, UNFPA has provided direct support for over 129,000 fistula repairs, and partners, such as EngenderHealth, the Fistula Foundation, the Freedom from Fistula Foundation, Direct Relief, the United Nations Federal Credit Union Foundation, Focus Fistula, Women and Health Alliance International and the Kupona Foundation, have provided support for thousands more. UNFPA and the Campaign to End Fistula were awarded the Un...

 RECOMMENDATIONS  Ensure investments to enhance fundamental obstetric services ; strengthen reproductive and maternal and newborn health-care systems with adequate well-trained, skilled medical personnel (i.e. midwives, doctors, surgeons, nurses and anaesthetists), infrastructure and supplies; ensure functioning quality assurance and monitoring mechanisms; and implement strategies to ensure timely access to safe and high-quality surgical repair, including during public health emergencies;    Implement and monitor human rights-based, gender-sensitive and multisectoral national strategies, policies, action plans and budgets to eliminate obstetric fistula by 2030 . Plans and budgets must incorporate the prevention and treatment of fistula and the socioeconomic reintegration and follow-up of fistula patients into programming and budget for achieving the Sustainable Development Goals (including preventing child marriage and adolescent pregnancy and ending gender-based vio...

RECOMMENDATIONS  Increase national budgets for health care and invite the international community to assist with national efforts , upon request, ensuring that adequate funds are allocated to universal access to health care, including strengthening health systems to provide essential maternal health services (high-quality family planning, prenatal, emergency obstetric and postnatal care, and skilled birth attendance) to women and girls, including those living in underserved rural areas where obstetric fistula is most common;  Ensure that national policies and programmes address inequities and reach poor and vulnerable women and girls who are at increased risk , owing to worsened poverty caused by the COVID-19 pandemic, including through the provision of targeted financial relief; the provision of free or adequately subsidized maternal and newborn health-care and fistula treatment under a framework of universal health coverage; and opportunities for community engagement and act...

RECOMMENDATIONS  Ensure holistic social reintegration services for all fistula survivors , including those deemed incurable or inoperable, including health care, counselling, education, socioeconomic empowerment and family and community support;  Develop and strengthen systems and follow-up mechanisms to make fistula a nationally notifiable condition , including indicators to track the well-being and reintegration of fistula survivors, ensuring a human rights-based approach;  Develop strategies to include community engagement to assist women in preventing another fistula after successful repai r, including through education, family planning and caesarean delivery planning;