Ending fistula within a generation: making the dream a reality
Authors: Erin Anastasi, Lauri Romanzi, Saifuddin Ahmed, Anneka T Knuttson, Oladosu Ojengbede, Kate Grant
Journal: The Lancet Global Health (2017)

1 year ago, on May 23, 2016, the International Day to End Obstetric Fistula, the then UN Secretary-General challenged the international community to end obstetric fistula within a generation.1Moon BK Secretary-General's message on the International Day to End Obstetric Fistula.https://www.un.org/sg/en/content/sg/statement/2016-05-23/secretary-generals-message-international-day-end-obstetric-fistulaGoogle Scholar This is a goal not only worthy of but mandatory for achieving the Sustainable Development Goals (SDGs)2UNSustainable Development Goals.http://www.un.org/sustainabledevelopment/sustainable-development-goals/Google Scholar by 2030. Obstetric fistula, caused by prolonged obstructed labour, is entirely preventable and, in most cases, treatable.3WHO10 facts on obstetric fistula.http://www.who.int/features/factfiles/obstetric_fistula/en/Google Scholar Despite being eliminated from the landscape in wealthy countries over a century ago,4Wall LL Arrowsmith SD Briggs ND Browning A Lassey A The obstetric vesicovaginal fistula in the developing world.Obstet Gynecol Survey. 2005; 60: S3-S51Crossref PubMed Scopus (112) Google Scholar the majority of the world's women and girls continue to be exposed to this risk in 2017 and many women with fistula will die without ever being treated. This persistence of risk and lack of access to care for obstetric fistula is a prime indicator of egregious global health inequity that illustrates all too painfully the critical need for intelligent, strategic mobilisation of resources to bridge this intolerable gap. Closing the gap is vital to bringing maternal health in low-income countries on par with standards achieved in high-income countries over 100 years ago. On Oct 24–25, 2016, partners of the UNFPA-led Campaign to End Fistula gathered in Abuja, Nigeria, for the biennial International Obstetric Fistula Working Group meeting, held in concert with the 2016 conference of the International Society of Obstetric Fistula Surgeons. Attending stakeholders rallied around the UN Secretary-General's call to action. It was here that the Minister of Health of Nigeria, Isaac Adewole, pledged to “end fistula within a generation” through “reprioritization of obstetric fistula as a public health and human rights issue in Nigeria's health agenda”, increasing health-care financing for fistula, expanding Nigeria's system of national fistula centres, and facilitating “everything possible to stop all new cases of obstetric fistula in Nigeria”. The meeting resulted in a general consensus for a Joint Call to Action to develop a global strategy to end fistula within a generation. As recommended in the Secretary-General's 2016 report on obstetric fistula,5UNIntensifying efforts to end obstetric fistula: report of the Secretary General.http://undocs.org/A/71/306Google Scholar we assert that a global strategy that will guide, build upon, and link to national strategies and action plans is mandatory for ending fistula within a generation. Success will require the integration of fistula into key global, regional, and national health and human rights initiatives, including SDGs 1, 3, 5, 10, and 17, WHO's Global Initiative for Emergency and Essential Surgical Care,6WHOGlobal Initiative for Emergency and Essential Surgical Care.http://www.who.int/surgery/globalinitiative/en/Google Scholar USAID's Maternal and Child Survival Programme,7USAIDMaternal & Child Survival Program.http://www.mcsprogram.org/Google Scholar the Global Strategy for Women's, Children's, and Adolescents’ Health,8UNGlobal Strategy for Women's, Children's & Adolescents’ Health (2016–2030).http://globalstrategy.everywomaneverychild.org/Google Scholar and robust engagement of the academic sector. Global stakeholders must mobilise now, in 2017, to create an achievable, harmonised, time-bound, adaptable and well-resourced agenda. We need a new path to the long overdue eradication of obstetric fistula that focuses on the basic formula of prevention of new cases and treatment of existing ones. Equally, the full empowerment of women and girls who have suffered fistula mandates holistic social reintegration approaches that address their physical, mental, psychosocial, educational, financial, and legal needs. This will require political will, governmental ownership, and increased investment in fistula-affected countries, including national fistula eradication strategies that are also costed, time-bound, integrated into safe surgery and maternal and newborn health policies, and implemented through strategic action plans monitored by both national fistula task forces and national safe surgery task forces. Analysis of the conditions under which fistula was eradicated in North America, the UK, and western Europe in the early 1900s forces us to admit that the capacity to eradicate the prolonged, obstructed labour that causes obstetric fistula has been in our hands for several generations. This condition of flagrant inequality, gross inequity, and moral and physical exclusion presents a human rights challenge that the global community must not and cannot ignore if it is to achieve the SDG 2030 vision of leaving no one behind.9UN General Assembly (Third Committee)Resolution A/C.3/71/L.16/Rev.1: intensification of efforts to end obstetric fistula.http://www.endfistula.org/sites/endfistula.org/files/pub-pdf/UNGA%2071-%20Resolution%20on%20Obstetric%20Fistula.pdfGoogle Scholar Women and girls living with fistula are among the most “left behind”: the world must ensure that obstetric fistula is eliminated. We declare no competing interests.