Childbirth is often celebrated as a joyous and magical event, symbolizing the beginning of a new life. However, for many women, especially in Africa, this moment of joy is overshadowed by the risk of obstetric fistula, a preventable condition that, for decades, reduces the health, dignity, and ability to cope with motherhood.
Obstetric fistula is a devastating condition resulting from prolonged labor and obstruction without timely medical intervention. This leads to a hole between the birth canal and the bladder and / or rectum, causing a lack of body control.
A 2004 World Health Organization (WHO) report said that two to three million women worldwide were living with untreated fistulas in the early 2000s, with Africa responsible for the most. The report estimates 50,000 to 100,000 new cases each year, indicating an urgent need for global action.
In response, The United Nations Population Fund (UNFPA) and its partners launched the Global Campaign to End Fistula in 2003, which aims to eliminate obstetric fistula. The campaign is currently active in 55 countries. It focuses on four strategies: prevention, treatment, social reintegration, and advocacy, all driven by human rights principles such as non-discrimination, participation, and accountability.
Significant progress has been made since then. UNFPA reported a drop in new fistula cases to around 500,000, a testament to the combined efforts of various stakeholders.
This shows that this war is a collaborative effort if we want to achieve our goals. In Kenya, an example of this is the partnership between the M-PESA Foundation, Amref Health Africa, and the Flying Doctor’s Society of Africa, among other partners. The “Integrated Fistula Program” aims to eliminate fistula in Kenya by 2030.
With an investment of KES 200 million, the program focuses on increasing public awareness, strengthening the district health system, and improving the reintegration process for fistula survivors. It targets several counties including Bungoma, Kilifi, and Kiambu, with activities such as corrective surgery, Sexual and Reproductive Health (SRH) services, media campaigns, training of health workers, and the creation of support groups to help reintegration. The initiative also emphasizes comprehensive care from prevention to post-surgical reintegration and increases planning, funding, and coordination of SRH services.
Despite progress, substantial gaps remain. By using technology and partnerships, we can create a database that gives a clear picture of the areas in Kenya most affected by fistula cases, so we can intervene more quickly. These interventions may also reduce the distance women travel to access these services.
Corrective surgery is the main treatment for fistulas, but a global shortage of fistula surgeons means that only one in 50 women receive the surgery they need. This lack of trained professionals is an important barrier to our ongoing efforts to fight fistula and restore the dignity of our women.
Beyond the shortage of surgeons, we also have a rare health care center for fistula cases. Emergency obstetric treatment and surgery, which are essential to prevent and treat fistula, are often out of reach.
Cultural practices such as female genital mutilation (FGM) and early marriage significantly increase the risk of labor obstruction and fistula. In addition, lack of awareness about the condition leads to social stigma. Women with fistulas often face hostility, which adds emotional and psychological trauma to the physical pain.
Until 2030, we must prioritize comprehensive systemic change to complement initiatives underway to eliminate obstetric fistula. This requires improving health care systems by investing in infrastructure, training, and referral networks to enable universal access to high-quality maternal care.
Additionally, incorporating comprehensive sex education into curriculum and outreach programs can empower women and girls to make informed decisions and seek timely medical care. This education will also benefit men, who are often the perpetrators of stigma, creating a more supportive environment for affected women.
By prioritizing marginalized communities and addressing the gaps that exist, we can create an environment where every woman can give birth safely and with dignity without the burden of obstetric fistula.
With less than ten years left to reach the United Nations targets, there is an urgent need to scale up our efforts. Reflecting on two decades of progress, we must now focus on the road ahead. All stakeholders, governments, NGOs, health providers, and private sector partners must strengthen their commitment, innovate solutions, and solidarity to end obstetric fistula by 2030.
Every woman deserves to live free from this preventable condition, and together, we can make it a reality.
The author is Chairman, Safaricom Foundation.