Living testimony: obstetric fistula and inequities in maternal health

Living testimony: obstetric fistula and inequities in maternal health

Obstetric fistula is an injury to the birth canal, resulting from prolonged labour, that has devastating physical and psychological effects on women’s lives. Its persistence reveals vast inequities in access to and quality of reproductive health care.

This report brings together the voices of women from 29 countries in Africa, the Arab States, and Asia, who speak out about life with obstetric fistula. Their families, community members, and health care providers share knowledge, attitudes, and perspectives on pregnancy, delivery, and fistula. This advocacy publication presents promising practices and strategic recommendations for policy makers, programmers, and researchers seeking to improve access to vital maternal health services and strengthen fistula prevention and treatment programmes in affected countries.

Country-level needs assessments highlighted the following recommendations for policy makers, programme managers, and researchers for appropriate and comprehensive prevention, treatment, and reintegration programmes:

  • promote legislation and policies to reduce maternal mortality and morbidity, and address underlying sociocultural factors
  • strengthen health system capacity to provide skilled maternity care that is accessible, affordable, and culturally acceptable
  • strengthen health system capacity to manage obstetric fistula sensitively, ensuring that care and treatment are subsidised and accessible
  • raise awareness on sexual and reproductive health and reproductive rights to address obstetric fistula
  • promote the empowerment and reintegration of women into communities post-surgery
  • involve women who have lived with fistula as equal participants in maternal health programme planning, implementation, and evaluation
  • promote partnerships to share key lessons and to catalyse collective action
  • support research on obstetric fistula to improve understanding of the impact of maternal morbidity and barriers to accessing vital reproductive health services
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