Measuring the incidence and prevalence of obstetric fistula: approaches, needs and recommendations

Obstetric fistula – an abnormal connec-tion between the vagina, rectum and/or bladder – may develop after prolonged and obstructed labour and lead to continuous urinary or faecal inconti-nence. Most fistulas occur in countries in sub-Saharan Africa or south Asia with poorly-resourced health systems. Women with obstetric fistula are indica -tors of the failure of health systems to deliver accessible, timely and appropriate intrapartum care. Incidence and preva-lence measurements of obstetric fistula are needed to sustain interest in – and funding for – sustainable methods for prevention and treatment. Knowing the absolute numbers of women requiring treatment is also essential for effective health-care planning.Incidence and prevalence estimates of obstetric fistula are generally based on self-reporting, personal communica -tion with surgeons, studies by advocacy groups and reviews of hospital services in which the relevant denominators are unknown or unreported.