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Let’s Eradicate Obstetric Fistula and Restore Dignity for Women

We don’t hear much about fistula here in North Carolina. But many women across sub-Saharan Africa and Asia know it all too well.

Every day, some 326 babies are born in North Carolina. Those babies and their mothers are fortunate—we live in a state with a strong health care system, and we have the benefit of first-rate hospitals, medical research, and pharmaceutical development right in our back yards.

For every 1,000 babies born in North Carolina, seven will die in infancy. This is seven too many, but in a global sense, we are far more fortunate than many other countries. In Mali, for instance, 78 of every 1,000 babies die before they reach their first birthdays.

And far too often, mothers fare little better than their lost children. Many women die in childbirth or suffer life-altering disabilities.

Imagine for a moment: After many long months of looking forward to the birth of your child, you suffer a prolonged, excruciating labor, and give birth to a stillborn baby. You are traumatized, both bodily and emotionally. Then you realize with horror that you are now chronically incontinent and prone to infections. Your family abandons you. You’re left to live alone, sick and unable to provide for yourself, on the fringes of your community. Your health and dignity have been stripped away.

Over 2 million women around the world are experiencing this right now, all because of a childbirth injury called obstetric fistula. A consequence of prolonged or obstructed labor, a fistula is a hole that forms between the vagina and the bladder and/or rectum. It will not usually heal on its own and can last for decades if left untreated.

We don’t hear much about fistula here in North Carolina, thanks largely to our strong health system. But many women across sub-Saharan Africa and Asia know it all too well.

The happy news is that obstetric fistula is entirely preventable. All it takes is a trained, observant health worker to recognize the danger signs and provide mothers with the care they need to deliver their babies—safe and alive.

And more happy news: When obstetric fistula does occur, it is almost always curable with a surgery to close the wound.

Why, then, do 2 million women continue to suffer from it?

Because many countries do not have the relative wealth of health workers that we enjoy in North Carolina. (Though even here, there are not enough nurse practitioners and other health workers to meet everyone’s needs). In fact, according to the World Health Organization, there is a global shortage of 7.2 million doctors, nurses, and midwives—the very health workers who can prevent fistulas from occurring.

For instance, in 2008, Mali had just one doctor with the skills to perform complex fistula repair surgeries. One doctor in a country that is home to 15.3 million inhabitants and is vaster than Texas and California combined.

That is why one North Carolina-based nonprofit, IntraHealth International, began training more fistula surgeons in Mali and working to get the word out to women with fistulas—many of whom are in remote areas and don’t even know their conditions can be treated—that help was on the way. After much suffering, these women had a chance at health, happiness, and dignity once more.

Now, through its new Restore Dignity campaign, IntraHealth is working to give even more women in Mali this chance. They are training more surgeons in more regions throughout the country, providing hundreds of fistula repair surgeries, establishing care centers to address women’s psycho-social needs, and fostering entrepreneurial opportunities so that, when they do rejoin their communities, recovering women can support themselves.

These are the kinds of lasting solutions that strengthen countries’ health systems for the long haul.

As Secretary-General Ban Ki-moon of the United Nations says: “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.”

Obstetric fistula is certainly an injustice we can eradicate. We have the solutions we need to transform the lives of millions of women around the world. But we must invest in those solutions.

This Saturday, May 23, is the International Day to End Obstetric Fistula. Let us take this opportunity to join forces, help more babies survive their births, and restore dignity for women in Mali and around the world.

To learn more, please visit the Restore Dignity campaign at