First-Ever Day to End Fistula Brings Attention to Progress, Challenges


Marking the firstever International Day to End Obstetric Fistula on May 23, Direct Relief is intensifying its decade-long efforts to prevent obstetric fistula and expand life-restoring surgical treatment for the estimated two million women – overwhelmingly in developing countries – who suffer from the devastating birth injury.

For more than ten years, Direct Relief has supported fistula repair centers throughout Africa and Asia with donations of essential medical supplies to enable fistula-repair surgeries and, in partnership with the United Nations Population Fund (UNFPA) and The Fistula Foundation, created the Global Fistula Map to consolidate and publish information on fistula treatment capacity and activity worldwide and help direct resources.

Obstetric fistula is a hole in the birth canal that is caused by prolonged and obstructed labor. If untreated, a woman with obstetric fistula will experience constant and uncontrollable leakage of urine and/or feces. In addition to physical injuries, many women with fistula suffer humiliation, isolation, and stigma as a result of the smell and constant leakage. And in most cases of obstructed labor in which a fistula develops, the baby is stillborn.

Fistula was once common throughout the world, but over the last century has been virtually eradicated in Europe and North America through improved medical care.  In the United States the last fistula hospital, now the site of the Waldorf Astoria Hotel in New York, closed in 1895 because of diminishing cases.

“Two million women living with this disabling and often isolating  condition after having suffered the loss of a child is an enormous human tragedy that is hidden in plain sight because the nature of the condition and where the women live,” said Lindsey Pollaczek, Senior Program Manager for Direct Relief. “Because fistula has been virtually eliminated in the developed world for more than a century, we know it can be done everywhere, and we are working to make that a reality for all women no matter their economic situation.”

Surgical and medical supplies are a critical component of fistula care and can be expensive and difficult to obtain in areas of high need. To ensure health providers have a reliable flow of supplies to improve access to treatment, Direct Relief maintains a robust inventory of surgical and medical supplies to meet the diverse needs of fistula care providers across the world.

Having helped launch the world’s first Global Fistula Map, Direct Relief is expanding support to fistula repair centers in 15 countries based on the information gathered.  The incidence of new fistula cases and

the prevalence of the condition has traditionally been very elusive due to the stigmatizing nature of the condition itself and because it typically occurs in areas lacking basic health services and related public-health reporting.

Global data from 42 countries released on the Global Fistula Map reflects a grim future for most of the estimated two million women living with obstetric fistula worldwide and more than 50,000 women who suffer the devastating birth injury and stigmatizing physical condition each year.

The Global Fistula Map is an evolving collaborative effort developed by Direct Relief and can be found at While the reported availability of surgical treatment for obstetric fistula is growing, the current capacity of most fistula treatment facilities remains limited.  Less than 10 percent of health facilities treat more than 200 women per year and nearly half of all facilities have only one or no surgeons permanently on-site. To learn more about Direct Relief’s efforts to address fistula and help spread the word, visit

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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