concentration of women afflicted with this horrendous condition – 2 million
women living with untreated fistula. 6 Annually, about 50,000 to 100,000
women globally succumb to fistula, 7 and this has grave implications for
global efforts at promoting maternal health. Identified as one of the five major
causes of maternal morbidity and mortality8, obstructed labor, which is
directly linked to the development of fistula, is responsible for up to 6 percent
of maternal deaths worldwide. 9
This is how the United Nations Population Fund (UNFPA) sums up the
circumstances that result in fistula:
Obstetric fistula is a childbirth injury that . . . is usually caused by
prolonged, obstructed labour, without timely medical intervention—
typically an emergency Caesarean section. During unassisted, prolonged,
obstructed labour, the sustained pressure of the baby’s head on the
mother’s pelvic bone damages soft tissues, creating a hole—or fistula—
between the vagina and the bladder and/or rectum. The pressure deprives
blood flow to the tissue, leading to necrosis. Eventually, the dead tissue
comes away, leaving a fistula, which causes a constant leaking of urine
and/or feces through the vagina. 10
In consequence of urinary incontinence, women, like Wobete, who
experience fistula, often suffer social isolation, skin infection, kidney
disorder and, if left untreated, death. 11 But the real tragedy lies not in
physiological pathology; it reaches much deeper. As Catherine Hamlin,
Australian gynecologist and founder of the Addis Ababa Fistula Hospital,
All the women who reach the gates of the hospital feel that their lives have
been ruined . . . They have no self-worth and have become social outcasts
from their community at a very young age through no fault of their own.
They’ve suffered all this injury unnecessarily because they haven’t got
enough obstetric care in the provinces. 12
6. 10 Facts on Obstetric Fistula, WORLD HEALTH ORG., http://www.who.int/features/
factfiles/obstetric_fistula/en/ (last updated May 2014) [hereinafter WORLD HEALTH ORG., 10
Facts]; Maternal Health, WORLD HEALTH ORG., (October 12, 2015, 10: 15 AM)
http://www.who.int/topics/maternal_health/en/ [hereinafter WORLD HEALTH ORG., Maternal
7. E.g., Obstetric Fistula: A Tragic Failure to Deliver Maternal Care, UNITED NATIONS
POPULATION FUND, http://www.unfpa.org/public/home/mothers/pid/4386 (last updated June
8. WORLD HEALTH ORG., Maternal Health, supra note 6.
9. WORLD HEALTH ORG., 10 Facts, supra note 6.
10. When Childbirth Harms: Obstetric Fistula, UNITED NATIONS POPULATION FUND,
supra note 4, at 2.
11. WORLD HEALTH ORG., 10 Facts, supra note 6.