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:
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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.
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  • 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, Expanded Efforts to Overcome Barriers to Care


Obstetric Fistula

On May 23, 2014, the second annual International Day to End Obstetric Fistula, Direct Relief released the annual update of the Global Fistula Map (more below) – a partnership with the United Nations Population Fund (UNFPA) and the Fistula Foundation to consolidate global data on treatment access for fistula. With this update, the Global Fistula Map serves an even more robust function for organizations in their efforts to prevent obstetric fistula and increase life-restoring surgical treatment for the estimated one million women who suffer from the devastating birth injury.

Obstetric Fistula Explained

Obstetric fistula is a hole in the birth canal  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.

In the year since the first International Day to End Obstetric Fistula was recognized, the efforts of many organizations and doctors around the world helped provide more than 14,000 estimated repair surgeries to women who were able to access care. However, the growing number of such life-restoring surgeries still doesn’t meet the needs of  women newly developing the condition. With the scourge of fistula still growing, the fight is far from over. However, progress is being made to help turn the tide.

Major Challenges to Ending Obstetric Fistula

Major barriers stand in the way of ending fistula, and overcoming them requires partnerships among many organizations, none of which can fully address the challenges alone.  Below are three of the major challenges to ending obstetric fistula and how Direct Relief is taking part in the efforts.

Global fistula map version 3

1. Documenting the Extent, Location of Fistula Cases and Raising Awareness

Direct Relief’s Global Fistula Map survey found that the number one reported barrier to a woman accessing care and treatment for her obstetric fistula is lack of knowledge that help is available. An overwhelming 78 percent of facilities chose this lack of awareness as one of the top three reasons women do not go to their facility for care.

Not only is it an issue that the women with fistula often do not know what their condition is or how to treat it, but most people in general are not aware of it. 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.  This means the countries with the biggest ability to aid the efforts have very few people who know what obstetric fistula is. Without broader awareness, it is difficult to find the support needed to reach the goal to end fistula.

To better help people understand what fistula is, where fistula exists, and where it is being treated, Direct Relief, 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.

With this third update of the map, there are now four years of data that cover 262 facilities in 44 countries. Included in the map are also stories of the surgeons and women who bring the fight to end fistula to the fore of the work they do and the lives they now lead. The Global Fistula Map provides a range of information for anyone looking to learn more about the disease that can then be shared with others to help bring awareness to this devastating condition.


2. Reducing the Cost of Surgeries by Providing Essential Surgical and Medical Supplies

Surgical and medical supplies are a critical component of fistula care and can be expensive and difficult to obtain in areas of high need. According to the most recent Global Fistula Map survey, 64 percent of facilities reported that costs were a barrier to expanding treatment.

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. For more than ten years, Direct Relief has supported fistula repair centers throughout Africa and Asia with donations.

Direct Relief’s Fistula Repair Module includes essential medicines and surgical supplies and is provided at no cost to facilities providing fistula repair surgery worldwide. In the last year alone, Direct Relief has supported 18 hospitals in 14 countries with more than $650,000 in medicines and supplies – enough to support over 2,000 repair surgeries. This support will continue to grow going forward as Johnson & Johnson has made a Clinton Global Initiative commitment to provide Direct Relief with enough sutures to help facilitate 7,500 repair surgeries.

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3. Expanding Surgical Expertise for Fistula Repair

Obstetric fistula surgical expertise is a very scarce skill that involves several medical specialties, including urology, obstetrics, gynecology, skin graphs and more.  In most of the high-poverty countries and areas countries where obstetric fistula occurs, the scarcity is more severe because of general shortages that exist for trained health professionals.

Moreover, since the condition typically affects only women who themselves are very poor, few if any financial incentives exist for surgeons to develop the range of skills needed and then devote their time to these procedures. Lack of surgical staff trained in obstetric fistula surgery was cited by almost half of Global Fistula Map facilities as being a limiting factor in the facility’s capacity to provide care.

Direct Relief’s efforts to identify and map the global points of care for fistula repair surgery (#1, above) is an essential element of the organization’s strategy noted above (#2, above) to furnish essential material resources that otherwise would only add to the cost barrier of restorative surgery.

In addition to targeting material support for fistula surgeries broadly, Direct Relief is working closely with health facilities and doctors who conduct fistula repair trainings to link specialized training resources. Dr. Steve Arrowsmith, who has dedicated much of his time to training others on fistula surgery, is a valued partner and serves as a key adviser to Direct Relief’s obstetric fistula programs (as well as those of our partners), helping foster key linkages to surgical expertise and Direct Relief target for support facilities that are investing not only in the women cared for, but the staff who care for them.

How You Help Prevent Obstetric Fistula:

Donate to Direct Relief’s efforts

$25 can provide the tools needed for a trained midwife to protect a mother during birth and deliver a baby safely, helping prevent an obstetric fistula from developing.

$50 can be leveraged into nearly $2,500 worth of wholesale medical aid to stock fistula repair facilities with the medical supplies they need.

$100 can provide dignity kits to comfort five women living with obstetric fistula, a devastating childbirth injury.

$1000 can provide one life-restoring fistula repair surgery and post-rehabilitative treatment for a woman suffering from this devastating birth injury.

Spread the Word

Many of these women are abandoned by their communities and shunned from their social circles, leaving them without a voice. Be their advocate by telling your friends, family, and other people you meet about this devastating condition and how they can help end fistula. Whether you tweet, text, or talk, find ways to raise awareness.

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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