Sexual and reproductive health

Improving access to high quality care for obstetric fistula

Results from a randomized control trial: reducing post-operative catheterization from 14 days to 7

“Fistula is fully preventable when all women and girls have access to high-quality, comprehensive sexual and reproductive health services [...] Let us join forces to eliminate this global social injustice.”

United Nations Secretay-General Ban Ki-moon

Obstetric fistula is the result of prolonged, obstructed labour. It leaves women incontinent, ashamed and often isolated from their communities. It is a debilitating condition affecting approximately 2 million women and girls across Africa and Asia. The exact number is difficult to estimate, however, due to a lack of commitment in addressing and resolving this problem and also a lack of awareness within the healthcare system.

Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric care services. There are numerous challenges associated with providing fistula repair services in developing countries, including a scarcity of available and motivated surgeons with specialized skills, operating rooms, equipment and funding from local or international donors to support both surgery and post-operative care.

An Ethiopian woman recovers from life-changing fistula surgery at the Hamlin Fistula Hospital in Addis Ababa, Ethiopia
An Ethiopian woman recovers from life-changing fistula surgery at the Hamlin Fistula Hospital in Addis Ababa, Ethiopia
Lucy Perry/Hamlin Fistula Relief & Aid Fund Australia

The Department of Reproductive Health and Research at WHO has embraced this challenge and taken leadership to expand necessary research to improve the lives of women affected by fistula and support the health system response. Together with EngenderHealth and USAID, WHO coordinated a multicentre trial to examine whether short-term (7 day) catheterization is not inferior to longer-term (14 day) catheterization in terms of fistula repair breakdown any time between 7 days and three months after catheter removal.


Simple female genital repair breakdown with 7 day versus 14 day catheterization: a randomised, controlled, open-label, non-inferiority trial

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This trial was conducted in the Democratic Republic of the Congo, Ethiopia, Guinea, Kenya, Nigeria, Niger, Sierra Leone and Uganda. 524 women with simple fistula were recruited over a period of 18 months and randomly allocated into two groups of 7 and 14 day catheterization. Results showed that short-term catheterization is safe and effective for managing women following repair of simple fistula. Additionally, there was no evidence of a significant difference in infections between the groups. Reducing the duration of post-operative urinary catheterization will also reduce the discomfort felt by women and allow for their earlier discharge.

Duration of catheterisation is the main determinant of length of hospital stay after fistula repair surgery, and early catheter removal has been shown to lead to early hospital discharge with other urinary tract surgery. In most resource-poor settings, funds are small, and the need for fistula services exceeds available human and infrastructure capacity. It therefore follows that fistula repair centres would be able to increase their caseloads using the same amount of resources if 7 day catheterisation was widely adopted after repair of simple fistula.