Kiddipedia
Wondering what one of the most tragic and completely preventable health conditions affecting women in poor communities is today?
It’s a condition that causes women to suffer in silence with shame, isolation and abandonment. However, there are programs to treat it for up to 100,000 new cases a year, if only women knew about them.
This is what you’ll learn:
- The truth about the overlooked health crisis
- Why obstetric fistula treatment programs are failing women in poor communities
- The real barriers to accessing treatment
- How to build an effective network for treatment
- The impact of grassroots approaches to treatment programs
The truth about the overlooked health crisis
Assume that only a small number of women have this condition?
Guess again. There are over 500,000 women with untreated obstetric fistula living in the world at any time. The majority of these cases are in sub-Saharan Africa and Asia. Fistula is an injury to the birth canal that develops during childbirth. It creates a hole between the vagina and the bladder or rectum, causing uncontrolled leaking of urine or feces from the body.
But wait, there’s more…
In 90% of cases, the baby dies. Women who are lucky enough to survive their birth injury are left to deal with a lifetime of social isolation, depression, and even greater poverty.
Here’s why it matters:
Obstetric fistula treatment programs in underserved areas are about more than providing women living in poor communities with medical care. It’s a matter of restoring dignity to women who have been abandoned by their husbands and families and ostracised by their communities.
The truth is that obstetric fistula has been virtually eradicated in developed countries. When emergency obstetric care and caesarean sections are available and accessible to all women, fistula just doesn’t happen.
In poor communities, women are forced to labour for days with no medical assistance. The prolonged pressure of a baby’s head on the pelvic bone cuts off the blood supply to surrounding tissues, which die and eventually fall away, creating a fistula.
Why obstetric fistula treatment programs are failing women in poor communities
Guess which condition is the number one killer of newly qualified doctors in rural Africa? Obstetric fistula. Women are dropping dead in their beds of preventable causes while the healthcare system is literally failing them at the basic level.
I’m not saying you should be a medical doctor in a sub-Saharan hospital just to save the lives of these women. But you should care.
Here’s something that may surprise you…
Solely 1 in 50 women with obstetric fistula receive treatment. This means that 98% of women living with the condition never even access treatment.
But why?
Lack of awareness is the biggest obstacle to accessing fistula treatment, and most women don’t even know it exists. They think their condition is the result of:
- Adultery
- A punishment they have to suffer
And when they do learn about treatment? Shame drives women to suffer in silence rather than risk the stigma of acknowledging their condition.
The real barriers to accessing treatment
Wanna know what actually works for reaching women living in poor communities?
You need to understand the real challenges women living in poor communities face when they decide to seek treatment. For many women with fistula, the travel time to a treatment centre is measured in days, not hours. A long, difficult journey is the last thing a woman with incontinence and serious social stigma wants to take.
The cost barrier is bigger than most people realize:
- Surgery costs (even if subsidised)
- Transport expenses
- Lost income during recovery
- Care for children left behind at home
But here’s what works according to the programs who have seen the most success…
Community awareness campaigns are a game-changer. When local faith leaders and other community leaders understand that fistula is a medical condition and not a curse, they become allies in the fight for treatment.
Kenya, for example, has established a Fistula Treatment Network. They don’t wait for women to come to them. Instead, they seek out patients from community organisations and through local health volunteers.
From 2014 to 2020, they were able to treat 5,720 women completely free of charge.
How to build an effective network for treatment
Guess what most people don’t realise about obstetric fistula treatment programs…
Success rates for surgery are sky-high. When properly repaired with surgical intervention, fistula has an 80-95% closure rate. That’s a better success rate than most common surgeries in developed countries.
So what makes for an effective obstetric fistula treatment program?
First, you need qualified surgeons. But more than just any surgeons – you need specialists who understand the unique challenges of fistula repair. In 2024, The International Federation of Gynaecology and Obstetrics had 90 Fellows who had received specialized training to work in the affected communities.
Second, wraparound care is critical. Programs that focus only on surgery miss the point. The best treatment programs provide:
- Pre-operative counseling and nutritional support
- Post-surgical rehabilitation
- Social reintegration programs
- Training in income-generating skills
The UNFPA has supported nearly 150,000 surgical repairs between 2003 and 2024. But surgery alone is not the answer.
Here’s why:
Women who have spent years living as outcasts with incontinence need to rebuild their lives. They’ve lost confidence, friends, partners, and economic independence. Effective programs address all of these needs.
The impact of grassroots approaches to treatment programs
Here’s what the real-world looks like…
In Ethiopia, where fistula prevalence is one of the highest in the world, only 43.3% of women of reproductive age even know what obstetric fistula is. But community-based awareness programs are making a difference.
Women who attended pregnancy conferences were almost four times more likely to have a good understanding of obstetric fistula prevention. Women who had access to media were twice as likely to be aware of the condition.
And it’s not just about awareness:
Ambassadors are the key. Survivors who have successfully undergone fistula treatment play a pivotal role in transforming their communities. These women:
- Share their stories without shame or stigma
- Educate pregnant mothers on the causes of fistula
- Dispel harmful myths about the condition
- Actively refer other women to treatment services
Programs using this approach are now active in Kenya, Bangladesh, Nigeria, Ghana and Liberia. Survivors become the proof that treatment works.
But wait, there’s more…
Mobile surgical units. Instead of waiting for women in rural areas to somehow find and travel to treatment facilities, the programs start bringing treatment to them. Chad has pioneered mobile clinic models to reach some of the most isolated and hard-to-reach populations. The mobile units doubled the number of women who were able to access treatment.
The economic impact is greater than many people realise. Women who have successfully been treated and reintegrated into their communities start businesses, care for their children, support their families, and contribute to the local economy.
Wrapping it up
Obstetric fistula treatment programs in underserved areas aren’t just about a medical condition. They’re about restoring dignity and hope to women living in poor communities who have been forgotten by the healthcare system.
The solutions are already there:
- Surgery is effective, up to 95% success rates
- Community awareness can break down stigma and myths
- Mobile treatment can bring care to remote areas
- Holistic support is needed for full recovery
Millions of women continue to suffer unnecessarily. The current system and resources are only able to reach 2% of women in need of treatment.
The real tragedy is that this condition is completely preventable. Access to skilled birth attendance and emergency obstetric care would eliminate new cases entirely.
Until that time, obstetric fistula treatment programs are the only hope for women living with the condition. And they work, when they are able to reach women who need them.
