News publications and other organizations are encouraged to reuse Direct Relief-published content for free under a Creative Commons License (Attribution-Non-Commercial-No Derivatives 4.0 International), given the republisher complies with the requirements identified below.

When republishing:

  • Include a byline with the reporter’s name and Direct Relief in the following format: "Author Name, Direct Relief." If attribution in that format is not possible, include the following language at the top of the story: "This story was originally published by Direct Relief."
  • If publishing online, please link to the original URL of the story.
  • Maintain any tagline at the bottom of the story.
  • With Direct Relief's permission, news publications can make changes such as localizing the content for a particular area, using a different headline, or shortening story text. To confirm edits are acceptable, please check with Direct Relief by clicking this link.
  • If new content is added to the original story — for example, a comment from a local official — a note with language to the effect of the following must be included: "Additional reporting by [reporter and organization]."
  • If republished stories are shared on social media, Direct Relief appreciates being tagged in the posts:
    • Twitter (@DirectRelief)
    • Facebook (@DirectRelief)
    • Instagram (@DirectRelief)

Republishing Images:

Unless stated otherwise, images shot by Direct Relief may be republished for non-commercial purposes with proper attribution, given the republisher complies with the requirements identified below.

  • Maintain correct caption information.
  • Credit the photographer and Direct Relief in the caption. For example: "First and Last Name / Direct Relief."
  • Do not digitally alter images.

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.

Other Requirements:

  • Do not state or imply that donations to any third-party organization support Direct Relief's work.
  • Republishers may not sell Direct Relief's content.
  • Direct Relief's work is prohibited from populating web pages designed to improve rankings on search engines or solely to gain revenue from network-based advertisements.
  • Advance permission is required to translate Direct Relief's stories into a language different from the original language of publication. To inquire, contact us here.
  • If Direct Relief requests a change to or removal of republished Direct Relief content from a site or on-air, the republisher must comply.

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

Updated Global Fistula Map Strengthens Efforts to End Fistula


A year after the launch of the first-ever Global Fistula Map, the largest and most comprehensive map of available services for women living with obstetric fistula, Direct Relief is pleased to release an updated version representing 17,878 patients at 238 sites in 42 countries with more data and new features.

The map was created by Direct Relief in partnership with The Fistula Foundation and the United Nations Population Fund (UNFPA), and represents a major step forward in understanding the landscape of worldwide treatment capacity for obstetric fistula.

Since last year, the map has helped improve coordination and allocation of resources to facilities while also raising awareness of the condition, which is little known in the developed world. According to currently accepted estimates, there are some 50,000-100,000 new cases of fistula every year.

Obstetric fistula, one of the most devastating childbirth injuries, is a hole in the birth canal caused by prolonged, obstructed labor when a woman goes hours or days without prompt medical attention. It is a highly stigmatizing condition, though in most cases is treatable through reconstructive surgery.

Having the right medical and surgical supplies is a critical component for helping women access fistula repair surgery. The Global Fistula Map enables Direct Relief to know where fistula repair surgery is available and increase the flow of medical and surgical supplies to those facilities, helping sustain and expand their ability to provide treatment to women in need.

Since the map launched, Direct Relief  has increased its network of fistula care provider partners by more than 50 percent, and now provides support to 18 hospitals in thirteen countries in Africa and Asia. In next 12 months, Direct Relief aims to enable 5,000 fistula repair surgeries.

The map has also been used by public health researchers to investigate the gap between demand and service provision for fistula repair as well as by foundations seeking to efficiently target funds to increase the number of women receiving treatment.

Additionally, the map was cited in the U.N. Secretary-General Report “Supporting Efforts to End Obstetric Fistula,” last fall as a significant step to streamline information on fistula-related activities – data that has been scarce, scattered, incomplete and difficult to obtain in the past.

Going forward, the Global Fistula Map will be continually updated, further refining our understanding of where treatment exists in order to strengthen collective efforts to help all women suffering from this condition.

New Features of the 2013 Global Fistula Map:

  • 64 new facilities reporting data, including facility data from Chad and the Central African Republic, two countries not represented on the map in 2012.
  • New data for rehabilitation and reintegration services.
  • New “From the Field” feature to highlight the stories of the women that have received this life-restoring treatment as well as the dedicated surgeons and health providers that have committed themselves to this cause.
  • New data on facilities’ source of financial support for fistula repair services
  • New information about membership in the International Society of Obstetric Fistula Surgeons (ISOFS)

Key Findings:

    • Capacity for fistula treatment remains limited: Less than 10% of health facilities treat over 200 women per year and nearly half of all facilities have only one or no surgeons permanently on-site.
    • About 20% of facilities report that they only provide fistula repair services periodically. These facilities treated a total of 1,379 women in 2011. Lack of permanent and consistent services suggests that there are likely women in those regions who otherwise might have received care.
    • Overall, there was a slight decrease in the average number of women that received fistula surgery at hospitals that submitted data for 2010 and 2011. However, there appear to be significant regional differences and this finding warrants further investigation to understand if the decrease might be influenced by changes in funding, human resource availability, or other specific factors.  Nonetheless, it does suggest that overall capacity for fistula treatment has not increased significantly from 2010 to 2011, despite the alarming number of women that continue to suffer from the condition.
    • Just under half (48%) of all hospitals responding offer any type of rehabilitation or reintegration services following fistula repair surgery—including physical therapy, psychosocial support, or income-generating activities. 37% of hospitals provide physical therapy while only 33% of hospitals provide psychosocial support or counseling services.
    • The majority of facilities (76%) receive financial support from non-governmental organizations to fund fistula treatment services. 14% of hospitals take payment from the fistula patient or her family (self-pay) to cover the cost of fistula repair surgery, which can be a significant burden to the family and barrier for accessing treatment.

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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