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Direct Relief often contracts with freelance photographers who usually, but not always, allow their work to be published by Direct Relief’s media partners. Contact Direct Relief for permission to use images in which Direct Relief is not credited in the caption by clicking here.

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For any additional questions about republishing Direct Relief content, please email the team here.

Obstetric Fistula: A Devastating But Fixable Health Issue


Fistula Repair Tools Gynocare Fistula Center, Eldoret, Kenya


Chances are you haven’t heard of obstetric fistula. That’s because Americans haven’t suffered from fistula since the 19th century, when a fistula hospital stood on the site of today’s Waldorf Astoria Hotel in Manhattan. Unfortunately, in developing countries where access to safe childbirth services is still limited, an estimated two million women continue to suffer from this devastating condition.

Obstetric fistula is primarily caused by prolonged and obstructed labor, when a woman goes for days without receiving essential obstetrical care such as a cesarean section.  The result of this difficult labor is the development of a hole, or fistula, in the birth canal.  If untreated, a woman with obstetric fistula will experience constant and uncontrollable leakage of urine and/or feces.  And in most cases of obstructed labor in which a fistula develops, the baby is stillborn.

In addition to the loss of her child and the physical injuries, the social trauma suffered by women with obstetric fistula is severe. The humiliation, isolation, and stigma as a result of the smell and constant leakage is devastating. Many women with fistula are abandoned by their husbands, taunted by community members, and ostracized from society.

An estimated 50,000 to 100,000 new cases develop each year, far surpassing the global capacity for treatment. Slowly, treatment services are expanding as more doctors are becoming trained to provide fistula repair surgery and more women with fistula are being identified and referred to treatment. At the same time, efforts to improve coverage of skilled providers at birth and increase access to emergency obstetric care to manage complications are helping to prevent new cases of fistula from occurring.

Since 2009, Direct Relief has

  • Provided medical and surgical supplies to 11 facilities in eight countries that provide life-restoring fistula repair to approximately 3,000 women each year.
  • Distributed over $1.3 million in medical resources from leading healthcare companies such as Johnson and Johnson, Ethicon, Covidien, BD, CR Bard, Hospira, and Henry Schein, to allow fistula surgeons to treat more women in need.
  • Collaborated with private foundations such as The Fistula Foundation to establish a surgical theater in Somaliland to increase availability of fistula treatment, and to train health providers in Western Kenya to ensure women with fistula are properly identified and receive adequate care and treatment.
  • Partnered with the Fistula Foundation and the United Nations Population Fund to launch the largest and most comprehensive Global Fistula Map of available services for women living with obstetric fistula. The release of the Global Fistula Map, a major step forward in understanding the landscape of worldwide treatment capacity for obstetric fistula, will help streamline the allocation of resources and raise awareness of the condition.

Your donation to our Maternal and Child Health program helps fund these programs.

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

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