Every year on May 23, the global community comes together to observe the International Day to End Obstetric Fistula, shining a long-overdue spotlight on a devastating, entirely preventable childbirth injury that destroys the lives of hundreds of thousands of the world’s most vulnerable women and girls. For 2026, the observation carries the guiding theme *“Her Health Is a Right: Invest to End Fistula and Childbirth Injuries”*, which emphasizes that ending this crisis demands bold political commitment and targeted financial investment to expand prevention, advance comprehensive care, and defend the fundamental reproductive rights of women across low- and middle-income regions.
Obstetric fistula develops most often when a person experiences prolonged, obstructed labor without access to timely, high-quality emergency obstetric care. The condition leaves survivors with continuous, uncontrollable leakage of urine, feces, or both, triggering a cascade of lifelong physical, social and psychological harm. Common complications include chronic infections, painful ulcerations, kidney disease, infertility, and in severe cases, death. Beyond physical harm, the constant odor associated with leakage fuels deep social stigma: many survivors are shamed by their communities, abandoned by family and friends, cut off from education and work opportunities, and pushed deeper into cycles of poverty. Isolation often leads to depression, suicidal ideation, and other chronic mental health struggles. “Obstetric fistula is not only a health problem, it is a condition that can isolate women and girls from their families, education, and other opportunities,” explains Nélida Rodrigues, UNFPA Representative in Mozambique, summarizing the far-reaching damage of the condition.
While the most common cause is unmanaged obstructed labor, two less-discussed forms of the injury also contribute to the global caseload. Iatrogenic fistulas can develop during gynecological procedures such as hysterectomies or Caesarean sections, when care is substandard and surgical providers lack adequate specialized training. In conflict zones, traumatic fistulas are a direct consequence of sexual violence, with damage to vaginal tissue classified as a permanent war injury.
Global data from the United Nations estimates that more than 500,000 women and girls currently live with obstetric fistula across sub-Saharan Africa, Asia, the Arab States, and Latin America and the Caribbean, with thousands of new cases diagnosed each year. The stark reality is that obstetric fistula has been virtually eliminated in high-income countries, where universal access to quality maternal health care, skilled emergency obstetric providers, and timely Caesarean sections ensure the condition is almost never allowed to develop. This gap exposes the deep inequities that define global health outcomes: as global income inequality continues to widen, the world’s poorest and most marginalized populations bear the brunt of systemic failures in health and social protection, with women and girls disproportionately impacted.
Multiple social and physiological factors amplify the risk of obstetric fistula. Poverty, a core driver of the crisis, is linked to early child marriage, restricted access to education and family planning, and widespread malnutrition. When girls become pregnant before their pelvises are fully developed, their risk of obstructed labor rises dramatically, and malnutrition, small stature, and overall poor pre-pregnancy health further compound this risk. While adolescent first-time mothers face the highest risk, older women who have previously given birth are also vulnerable to the condition.
Public health experts emphasize that ending obstetric fistula requires a multi-layered approach centered on accessible, high-quality care. Midwives play a uniquely critical role in prevention and care at every level: the International Confederation of Midwives notes that ending the crisis demands full integration of midwifery expertise across community, national, regional and global health systems. Core prevention strategies include expanding access to contraception and family planning to reduce unplanned and early pregnancies, and guaranteeing universal access to emergency obstetric care, including timely Caesarean sections when complications arise.
For women already living with the condition, the outlook is hopeful: obstetric fistula is highly treatable, and reconstructive surgery can repair damaged tissue, restore physical health, and help survivors reclaim their dignity. Beyond clinical care, long-term support for social reintegration is critical to helping survivors overcome stigma, rebuild their social connections, and access economic opportunities.
Dr. Natalia Kanem, Executive Director of the United Nations Population Fund (UNFPA), frames obstetric fistula as a clear symptom of global failure: it is a tragic outcome of systemic neglect of the reproductive rights of the most vulnerable and excluded women and girls. Moving forward, advancing progress requires governments to align their national health strategies with the United Nations Sustainable Development Goals, particularly SDG 1 (no poverty), SDG 3 (good health and well-being), and SDG 5 (gender equality) – three foundational goals that underpin all global development efforts.
On this year’s International Day to End Obstetric Fistula, global health leaders and advocates are calling on policymakers, donors, and civil society to amplify awareness of this dehumanizing crisis, mobilize widespread public support, and redouble collective global efforts to eliminate the condition. Ending obstetric fistula requires more than incremental change: it demands a renewed sense of global political urgency and sustained commitment to increase investment in prevention and treatment, strengthen under-resourced health systems, and ensure all women can access the care they need to thrive – and live with dignity – after childbirth.