Obstetric fistula is a devastating childbirth injury that develops during prolonged obstructed labor. The constant pressure of the baby’s skull against the soft tissues of a woman’s vagina cuts off blood supply, causing the tissues to disintegrate. A hole (or “fistula”) then forms between the vagina and bladder and/or between vagina and the rectum, leaving the woman to leak urine and/or feces continuously and uncontrollably from her vagina. In nearly all cases of obstetric fistula, the baby dies.(See the diagram.)

The consequences of fistula are devastating. Girls and women who sustain fistula typically live in acute poverty, and in rural areas. They often lack access to adequate health services and information, cannot pay for medical treatment, and are poorly educated. Left untreated, fistula can lead to frequent and painful rashes, infections, and ulcerations. Moreover, fistula inhibits women’s ability to work, thereby driving them deeper into poverty and further weakening their economic and social position.

Despite the enormous impact of fistula, most girls and women living with the condition are either unaware that surgery is available to repair fistula, or they cannot access or afford treatment once they learn it exists. As a consequence, many girls and women live years (if not decades) with fistula, are socially ostracized and ridiculed by their communities, or become so ashamed of their condition that they isolate themselves. Others are rejected and abandoned by husbands and families.

Despite these challenges, girls and women with fistula are typically strong and resourceful. They continue to support their families and themselves. They struggle and succeed to maintain their dignity in the face of enormous stigma and shame.