Of ‘Ending fistula within a generation’

Obstetric fistula is almost exclusively a condition of the poorest, most vulnerable and most marginalised women and girls. It afflicts those who lack access to the timely, high-quality, and life-saving maternal health care that they so desperately need and deserve, and that is their basic human right. As a doctor I am personally outraged that fistula, which is wholly preventable, still occurs in today’s world.

The theme of this year’s International Day to End Obstetric Fistula, “End fistula within a generation”, is a call to transform the world. As we talk about ending polio, HIV/Aids, female genital mutilation and so many other forms of suffering, so must we commit to stepping up our efforts to end fistula, once and for all. This means heeding the call of the 2030 Agenda for Sustainable Development to leave no one behind, especially those most neglected, invisible and powerless, including the women and girls living with fistula. Now is the time, and I am confident we can do it.

For every woman who dies, 20 or more are injured or disabled. One of the most serious injuries of childbearing is obstetric fistula. It is estimated that more than two million women and girls are still living with the condition in the developing world. It is a grave injustice that around the world, in the 21st century, the poorest, most vulnerable and marginalised women and girls, suffer needlessly from a devastating condition of fistula.

Many women and girls who suffer from fistula are excluded from daily community life and often abandoned by their husbands and families, isolating them socially and emotionally, making it also difficult to maintain a source of income or support, thus, deepening their poverty and magnifying their suffering. Now is the time to end this severely neglected health and human rights tragedy.

Let us commit to end obstetric fistula within a generation. The persistence of fistula reflects broader health inequities and health-care system constraints, as well as wider challenges facing women and girls, such as poverty, gender and socioeconomic inequality, lack of schooling, child marriage and early childbearing, all of which impede the well-being of and opportunities for women and girls.

To end fistula, we must ensure universal access to quality sexual and reproductive health services; eliminate gender-based social and economic inequities; prevent child marriage and early childbearing; promote education and broader human rights and foster community participation in finding solutions, including through the active involvement of men as well as seeking the help of fistula survivors as advocates. Ensuring access to fistula treatment for all women and girls in need is also a key strategy for eliminating it.

For UNFPA, ending fistula remains one of our highest priorities, and we will continue to accelerate efforts, both in our own work and within the United Nations system. The global Campaign to End Fistula, launched in 2003 by UNFPA and partners, has made significant progress towards eliminating fistula and supporting its survivors through prevention, treatment, social reintegration and advocacy. UNFPA has supported more than 70 000 fistula repair surgeries for women and girls in need and campaign partners have enabled many more to receive treatment.

It is also important that every fistula-affected nation systematically registers and tracks each and every woman and girl who has or has previously had a fistula. Many of those who developed a fistula during delivery remain untreated and many who have received surgical treatments do not receive the necessary medical and psycho-social follow-up, which puts them at risk in subsequent pregnancies.

Systematically, registering and tracking each woman and girl who has or has previously had a fistula helps to ensure, not only their long-term well-being, but also their babies’ survival in all subsequent pregnancies. n