Burden of obstetric fistula: from measurement to action

For every maternal death, an additional 20–30 women develop serious pregnancy-related complications. Among all maternal morbidities, obstetric fistula is one of the most devastating. It is caused by injury during childbirth, resulting in an abnormal opening between the vagina and the bladder (vesicovaginal fistula) or rectum (rectovaginal fistula), leading to continuous urinary or fecal incontinence. Obstructed labour is the most common cause of vesicovaginal fistula in low-income countries.1 Worldwide, an estimated 2–3 million women have obstetric fistula,1 almost exclusively in sub-Saharan Africa and south Asia.