International Day to End Obstetric Fistula

 Co-hosted by UNFPA and the UN Office for Partnerships, Member States, clinicians, advocates and youth will convene for a solutions-oriented discussion on what will it take to end fistula by 2030 and keep the promise of the SDGs. Obstetric fistula is a devastating and preventable childbirth injury — a stark reflection of poverty, inequality and gaps in maternal healthcare. Ending fistula is an indicator of progress on the 2030 Agenda, at the intersection of multiple Sustainable Development Goals, including: 1 on ending poverty, 3 on health; 5 on gender equality; 9 on infrastructure; 10 on reducing inequalities, and 17 on partnerships. Watch from Legacy to Lasting Change: Ending Obstetric Fistula by 2030 | Goals Lounge! Meetings & Events

This year's theme,  “Her health, her right: Shaping a future without fistula,”  underscores a powerful truth: that every woman and girl has the fundamental right to health—particularly sexual and reproductive health—and that the continued existence of obstetric fistula is a clear violation of that right. All women and girls have the right to high-quality, comprehensive sexual and reproductive health services – no matter who they are or where they live. No woman or girl should have to endure obstetric fistula . The devastating condition, which is caused by complications during childbirth, results in pain, isolation and indignity – and yet is entirely preventable and treatable. Ending fistula would improve maternal health and well-being overall and is essential to achieving universal health coverage. To build a future free of fistula , we must empower women and girls to make informed decisions about their sexual and reproductive health. High-quality, comprehensive care should be...

 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;

 RECOMMENDATIONS. Strengthen research, data collection, monitoring and evaluation to guide comprehensive policies, planning and implementation of maternal and newborn health programmes;   Develop, strengthen and integrate within national health information systems routine reviews of maternal and perinatal deaths and near-miss cases , such as obstetric fistula, as part of national maternal and perinatal death surveillance and response systems;    Develop community-based and facility-based mechanisms for the systematic notification of obstetric fistula cases to ministries of health and the recording of those cases in a national register, and acknowledge fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up, using a human rights-based approach;   Provide an enabling environment for social accountability by ensuring access to information on policies, programmes, budgets and specific services to prevent and a...

  RECOMMENDATIONS. Empower fistula survivors to raise awareness and mobilize communities, as advocates for fistula elimination and safe motherhood , and to participate actively in policy formulation, service design and delivery, human rights monitoring and accountability; Strengthen awareness-raising and advocacy , including through the media, schools, health-care facilities and community outreach programmes, with key messages on fistula prevention and treatment and social reintegration; (x) Mobilize communities, including religious and community leaders, women’s groups, civil society organizations, women and girls, men and boys, to advocate for and support universal access to health care, ensuring human rights, reducing stigma and discrimination; Ensure gender equality and the empowerment of women and girls, including through sexual and reproductive health and rights and holistic programming for them, recognizing that the well-being of women and girls has a significant positive e...

Global Campaign to End Fistula. Prevention in Côte d’Ivoire Averting serious childbirth injury can very much depend on who is in the delivery room. The UN has singled midwives out for their crucial role in “saving maternal and newborn lives and preventing morbidity, including obstetric fistula ”. But prevention efforts often occur well before the first pangs of labour. In Côte d’Ivoire, Pastor Kouakou Adou Kouamé – a member of the Ivorian Association for Family Welfare’s fistula support committee – works to spread information about the condition among and beyond his flock at the Bondoukou Baptist Church. “We raise awareness in the communities, the villages,” he said. “It is not only our faithful that we reach.” Pastor Adou uses his position at the pulpit to help people understand and avert the dangers of fistula. Particularly at weddings, he warns newlyweds against home births, which can heighten the risk of childbirth injury. “Soon a child will come,” he tells them. “When a woman is ...

About 800 women die from pregnancy, or childbirth-related complications around the world every day.  For every woman who dies of maternal related causes, it is estimated that at least 20 women experience a maternal morbidity, one of the most severe forms of which is obstetric fistula. Obstetric fistula is an abnormal opening between a woman’s genital tract and her urinary tract, or rectum caused by prolonged, obstructed labour without treatment. Between 50,000 to 100,000 new cases develop worldwide each year. Most fistulas occur among women living in poverty, in cultures where a woman’s status and self-esteem may depend almost entirely on her marriage and ability to bear children. Yet fistula is almost entirely preventable. Its persistence is a sign that health systems are failing to meet women’s essential needs. Obstetric fistula symptoms generally manifest in the early post-partum period. Other, equally severe symptoms, such as psychological trauma, deteriorating health, increa...

Resolution A/RES/73/147 on the intensification of efforts to end obstetric fistula calls upon States and the international community to accelerate actions to end fistul a and reiterates the need for urgent efforts and significantly increased investment to improve maternal health by addressing sexual and reproductive, maternal, newborn and child health. The document further outlines key recommendations and actions, and calls for the development of a Global Road Map to End Fistula within a decade. The General Assembly,  Recalling its resolutions 62/138 of 18 December 2007, 63/158 of 18 December 2008, 65/188 of 21 December 2010 and 67/147 of 20 December 2012 on supporting efforts to end obstetric fistula and its resolutions 69/148 of 18 December 2014 and 71/169 of 19 December 2016 on the intensification of efforts to end obstetric fistula, Reaffirming the Beijing Declaration and Platform for Action, 1 the outcomes of the twenty-third special session of the General Assembly, entitle...

Obstetric fistula  is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum,  Risk factors include  obstructed labor , poor access to medical care,  malnutrition , and  teenage pregnancy .  The underlying mechanism is  poor blood flow  to the affected area for a prolonged period of time.   Diagnosis is generally based on symptoms and may be supported by use of  methylene blue .  Obstetric fistula are almost entirely preventable with appropriate use of cesarean section . Treatment is typically by surgery. If treated early, the use of a urinary catheter may help with healing. Counseling may also be useful

Resolution  A/RES/67/147  on supporting efforts to end obstetric fistula.