Seizing the moment to end obstetric fistula
Authors: Babatunde Osotimehin
Journal: The Lancet Global Health (2014)

At the 47th UN Commission on Population and Development in April, countries renewed their commitments to accelerate universal access to sexual and reproductive health, and to protect reproductive rights, both of which, along with the protection of women's human rights, are critical for ending obstetric fistula.The Commission meets annually to debate population and development issues. Its resolutions can influence decisions of the General Assembly, which in September will review progress in implementing the Programme of Action of the 1994 International Conference on Population and Development. The General Assembly will also consider proposals for a new set of development goals to succeed the Millennium Development Goals.At this pivotal moment, the worldwide community has a unique opportunity to eliminate obstetric fistula, one of the starkest and most acute forms of inequality.Obstetric fistula represents our failure as a worldwide community to protect the health and human rights of women and girls, and achieve equity in the availability of, and access to, critical, life-saving sexual and reproductive health services. Virtually eliminated from developed countries, obstetric fistula continues to affect the poorest of the poor: women and girls living in the most deprived parts of the world.1WHOMaternal health.www.who.int/topics/maternal_health/en/Google Scholar In the words of UN Secretary-General Ban Ki-moon “Obstetric fistula… is still all too common in poorer countries where inadequate medical care and stigma combine to turn a preventable condition into a devastating one.”2Ban KM International day to end obstetric fistula. Secretary-General's message.http://www.un.org/en/events/endfistuladay/sgmessage.shtmlGoogle ScholarMaternal morbidity and disability are neglected aspects of maternal health.3Koblinsky M Chowdhury ME Moran A Ronsmans C Maternal morbidity and disability and their consequences: neglected agenda in maternal health.J Health Pop Nutr. 2012; 30: 124-130Crossref PubMed Scopus (71) Google Scholar The General Assembly's upcoming review of progress in implementing the International Conference on Population and Development (ICPD) and the debate on the post-2015 development framework are opportunities to remedy this neglect.Within the post-2015 framework, governments and other stakeholders are considering several goals, which could result in a new push for universal access to health, including sexual and reproductive health and rights,4UNFPAEmpowering people to ensure a sustainable future for all.http://www.unfpa.org/webdav/site/global/shared/documents/news/2013/Post%202015%20Position%20Paper.pdfDate: 2013Google Scholar gender equality, and the empowerment of women, girls, and young people (including adolescents). The achievement of these proposed Sustainable Development Goals would undoubtedly have a tremendous effect on the incidence of obstetric fistula through the overall improvement of, and increased access to, health care, and through government actions that could end harmful practices such as child marriage, which often leads to early childbearing and an increased risk of obstetric fistula.Other international efforts might also contribute to a reduction in the incidence and prevalence of obstetric fistula. These include: a movement led by WHO, USAID, and others to eliminate preventable maternal mortality by 2030;5Bustreo F, Say L, Koblinsky M, Pullum T, Temmerman M, Mendez AP. Ending preventable maternal deaths: the time is now. Lancet Glob Health 1: e176–77.Google Scholar the Every Newborn Action Plan to end preventable deaths;6WHOEvery newborn: an action plan to end preventable deaths.http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/Google Scholar the continuing work of the UN Commission on Life-Saving Commodities for Women and Children; efforts to improve maternal death surveillance and response; establishment of obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking, and follow-up; and the development or strengthening of national action plans for eliminating obstetric fistula through quality maternal and newborn health care for all women and girls, as well as treatment, rehabilitation, socioeconomic reintegration, and essential follow-up services for the estimated more than 2 million women living with obstetric fistula.7WHO10 facts on obstetric fistula.http://www.who.int/features/factfiles/obstetric_fistula/enGoogle ScholarJust as the world has witnessed a substantial reduction in maternal death in recent years (almost 50% reduction over the past two decades),8UNFPAUNICEFWHOWorld BankTrends in maternal mortality: 1990–2013. World Health Organization, Geneva2014http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1Google Scholar the same is possible for fistula. The vision of the worldwide Campaign to End Fistula, led by the United Nations Population Fund (UNFPA) and partners, is a world where, in the near future, no one will have heard of obstetric fistula because it will no longer exist.A world where women and girls need never again suffer the health, social, and economic effects of obstetric fistula is possible, especially if the world's new development framework focuses on women and adolescents; ensures universal and equitable access to health care, including emergency obstetric care; addresses the social determinants of health—stigma and discrimination; and promotes government accountability for protecting human rights.9The LancetA manifesto for the world we want.Lancet. 2012; 380: 1881Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar At the centre of dignity and rights for all are the elimination of poverty and inequality, and the creation of real opportunities for participation and social inclusiveness.10United Nations General AssemblyFramework of actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014. Report of the Secretary-General.http://issuu.com/shiralevine/docs/icpd_review_global_report_a_69_62_eGoogle ScholarUNFPA last year spearheaded a worldwide review of the ICPD Programme of Action. The findings of the review, released last February, noted that substantial gains have been made in improving indicators of sexual and reproductive health, but found that considerable disparities remain, with many people, especially the poor, lacking access to quality sexual and reproductive health services, including life-saving emergency obstetric care.10United Nations General AssemblyFramework of actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014. Report of the Secretary-General.http://issuu.com/shiralevine/docs/icpd_review_global_report_a_69_62_eGoogle ScholarWe have the technology, we have the knowledge, and we have the potential to reach this visionary yet achievable goal.On May 23, the International Day to End Obstetric Fistula, we call on the worldwide community to make the transformative shift of leaving no one behind,9The LancetA manifesto for the world we want.Lancet. 2012; 380: 1881Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar even those invisible in society, by seizing the moment to end fistula forever.I declare no competing interests. At the 47th UN Commission on Population and Development in April, countries renewed their commitments to accelerate universal access to sexual and reproductive health, and to protect reproductive rights, both of which, along with the protection of women's human rights, are critical for ending obstetric fistula. The Commission meets annually to debate population and development issues. Its resolutions can influence decisions of the General Assembly, which in September will review progress in implementing the Programme of Action of the 1994 International Conference on Population and Development. The General Assembly will also consider proposals for a new set of development goals to succeed the Millennium Development Goals. At this pivotal moment, the worldwide community has a unique opportunity to eliminate obstetric fistula, one of the starkest and most acute forms of inequality. Obstetric fistula represents our failure as a worldwide community to protect the health and human rights of women and girls, and achieve equity in the availability of, and access to, critical, life-saving sexual and reproductive health services. Virtually eliminated from developed countries, obstetric fistula continues to affect the poorest of the poor: women and girls living in the most deprived parts of the world.1WHOMaternal health.www.who.int/topics/maternal_health/en/Google Scholar In the words of UN Secretary-General Ban Ki-moon “Obstetric fistula… is still all too common in poorer countries where inadequate medical care and stigma combine to turn a preventable condition into a devastating one.”2Ban KM International day to end obstetric fistula. Secretary-General's message.http://www.un.org/en/events/endfistuladay/sgmessage.shtmlGoogle Scholar Maternal morbidity and disability are neglected aspects of maternal health.3Koblinsky M Chowdhury ME Moran A Ronsmans C Maternal morbidity and disability and their consequences: neglected agenda in maternal health.J Health Pop Nutr. 2012; 30: 124-130Crossref PubMed Scopus (71) Google Scholar The General Assembly's upcoming review of progress in implementing the International Conference on Population and Development (ICPD) and the debate on the post-2015 development framework are opportunities to remedy this neglect. Within the post-2015 framework, governments and other stakeholders are considering several goals, which could result in a new push for universal access to health, including sexual and reproductive health and rights,4UNFPAEmpowering people to ensure a sustainable future for all.http://www.unfpa.org/webdav/site/global/shared/documents/news/2013/Post%202015%20Position%20Paper.pdfDate: 2013Google Scholar gender equality, and the empowerment of women, girls, and young people (including adolescents). The achievement of these proposed Sustainable Development Goals would undoubtedly have a tremendous effect on the incidence of obstetric fistula through the overall improvement of, and increased access to, health care, and through government actions that could end harmful practices such as child marriage, which often leads to early childbearing and an increased risk of obstetric fistula. Other international efforts might also contribute to a reduction in the incidence and prevalence of obstetric fistula. These include: a movement led by WHO, USAID, and others to eliminate preventable maternal mortality by 2030;5Bustreo F, Say L, Koblinsky M, Pullum T, Temmerman M, Mendez AP. Ending preventable maternal deaths: the time is now. Lancet Glob Health 1: e176–77.Google Scholar the Every Newborn Action Plan to end preventable deaths;6WHOEvery newborn: an action plan to end preventable deaths.http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/Google Scholar the continuing work of the UN Commission on Life-Saving Commodities for Women and Children; efforts to improve maternal death surveillance and response; establishment of obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking, and follow-up; and the development or strengthening of national action plans for eliminating obstetric fistula through quality maternal and newborn health care for all women and girls, as well as treatment, rehabilitation, socioeconomic reintegration, and essential follow-up services for the estimated more than 2 million women living with obstetric fistula.7WHO10 facts on obstetric fistula.http://www.who.int/features/factfiles/obstetric_fistula/enGoogle Scholar Just as the world has witnessed a substantial reduction in maternal death in recent years (almost 50% reduction over the past two decades),8UNFPAUNICEFWHOWorld BankTrends in maternal mortality: 1990–2013. World Health Organization, Geneva2014http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1Google Scholar the same is possible for fistula. The vision of the worldwide Campaign to End Fistula, led by the United Nations Population Fund (UNFPA) and partners, is a world where, in the near future, no one will have heard of obstetric fistula because it will no longer exist. A world where women and girls need never again suffer the health, social, and economic effects of obstetric fistula is possible, especially if the world's new development framework focuses on women and adolescents; ensures universal and equitable access to health care, including emergency obstetric care; addresses the social determinants of health—stigma and discrimination; and promotes government accountability for protecting human rights.9The LancetA manifesto for the world we want.Lancet. 2012; 380: 1881Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar At the centre of dignity and rights for all are the elimination of poverty and inequality, and the creation of real opportunities for participation and social inclusiveness.10United Nations General AssemblyFramework of actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014. Report of the Secretary-General.http://issuu.com/shiralevine/docs/icpd_review_global_report_a_69_62_eGoogle Scholar UNFPA last year spearheaded a worldwide review of the ICPD Programme of Action. The findings of the review, released last February, noted that substantial gains have been made in improving indicators of sexual and reproductive health, but found that considerable disparities remain, with many people, especially the poor, lacking access to quality sexual and reproductive health services, including life-saving emergency obstetric care.10United Nations General AssemblyFramework of actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014. Report of the Secretary-General.http://issuu.com/shiralevine/docs/icpd_review_global_report_a_69_62_eGoogle Scholar We have the technology, we have the knowledge, and we have the potential to reach this visionary yet achievable goal. On May 23, the International Day to End Obstetric Fistula, we call on the worldwide community to make the transformative shift of leaving no one behind,9The LancetA manifesto for the world we want.Lancet. 2012; 380: 1881Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar even those invisible in society, by seizing the moment to end fistula forever. I declare no competing interests.