Sexual and reproductive health

Obstetric fistula: the untreated tragedy

About the study

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

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. In 2012-2013, 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 measured three months following surgery.


Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial

Related document

This trial was conducted in the 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. Preliminary results suggest that short-term catheterization is safe and effective for managing women following repair of simple fistula. Reducing the duration of post-operative urinary catheterization will reduce the discomfort among women and allow for earlier discharge of women, lowering the cost per repair as well as increasing capacity for treating additional fistula patients. Results of this trial will be available in the coming months.