CONAKRY, Guinea – “It happened at the hospital. I realized I was leaking urine,” fistula survivor Kadiatou Bah told UNFPA, the United Nations sexual and reproductive health agency.
Ms. Bah first fell pregnant more than four decades ago, when she was 17. With few health centres on hand in her mountainous village in Labé, Guinea, she’d had little chance to avail herself of services during her pregnancy; nor had she planned to give birth at a health facility.
But her plans changed after two days of labour. “When we wanted to go to the health centre, I gave birth on the way,” she said. “The child was already dead.”
Though she didn’t realize it at the time, Ms. Bah had suffered an obstetric fistula: A devastating childbirth injury that carries life-threatening risks for women and their pregnancies. About nine in ten women who develop obstetric fistula suffer stillbirths; meanwhile, research shows obstructed labour drives 6 per cent of maternal deaths.
Fistula’s effects are also severe for survivors; many encounter incontinence, mental and physical ailments and societal ostracization. Ms. Bah’s disability drove a wedge between her and her husband, who offered her little support. “I could no longer show myself in public,” she said. “People avoided me; I suffered a lot.”
A road to recovery
Half a million women and girls across the Arab States, Asia, Latin America and the Caribbean, and sub-Saharan Africa are estimated to be survivors of obstetric fistula. Many are girls and young women who, like Ms. Bah, were married as children and may have become pregnant before their bodies were developmentally ready.
According to 2018 data, about 124,000 women in Guinea are affected by obstetric fistula – more than 4 per cent of women of childbearing age in the country. Despite its prevalence, survivors of obstetric fistula remain subject to extreme levels of stigma. “Among the complications linked to pregnancy, obstetric fistula is one of the most serious, as it also causes social exclusion,” said Dr. Sékou Diallo, a gynaecologist in Mamou.
According to experts, caring for fistula survivors requires addressing their medical, psychosocial and socioeconomic needs. Most fistulas can be repaired via surgery, although this can be difficult to access given the global lack in surgeons trained to provide this care. In Guinea, for example, only one hospital in the country’s northeast regularly offers fistula repair surgeries.
Despite these challenges, more than 500 women were able to obtain free fistula care between 2018 and 2023.
Fistula-free
Ms. Bah had lived with obstetric fistula for almost 20 years before her first repair surgery. “I underwent a first operation, then [a second], but I was still losing urine,” she said. Following a third surgery in 2019, however, she was able to make a full recovery.
With UNFPA’s support, the Government of Guinea has developed a national strategy to combat obstetric fistula, creating fistula management units across seven regions of the country. Within these units, teams of surgeons, nurses and anaesthetists are trained to offer fistula repair surgeries to help women like Ms. Bah heal.
"Obstetric fistula is a tragic result of our failure to protect the reproductive rights of the most vulnerable and excluded women and girls,” said UNFPA Executive Director Dr. Natalia Kanem. “By addressing deep-rooted inequalities, reaching those furthest behind, and investing in universal access to timely, high-quality maternal health services, we can and must end fistula once and for all.”
