Obstetric Fistula: A Preventable Tragedy


  • Suellen Miller CNM, PhD,

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    • Suellen Miller, CNM, MHA, PhD, is Director of Safe Motherhood Programs, the Women's Global Health Imperative, University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, and Adjunct Assistant Professor, University of California, Berkeley, School of Public Health, Maternal and Child Health Program.

  • Felicia Lester MPH, MS,

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    • Felicia Lester, MD, MS, MPH, received her MPH in Maternal and Child Health through the University of California, Berkeley and the University of California, San Francisco Joint Medical Program.

  • Monique Webster MPH,

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    • Monique Webster, MPH, is a graduate of the Maternal and Child Health program at the University of California, Berkeley School of Public Health.

  • Beth Cowan MD

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    • Beth Cowan, MD, is a board-certified obstetrician/gynecologist, who is currently completing an obstetrics and gynecology fellowship at the VA Medical Center/University of California, San Francisco.

Suellen Miller, CNM, PhD, Women's Global Health Imperative, University of California, San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105-3444. E-mail: smiller@psg.ucsf.edu


Obstetric fistula disables millions of women and girls in developing countries, primarily in sub-Saharan Africa and South Asia. The United Nations Population Fund (UNFPA) recently launched a global campaign to end fistula, labeling this condition a preventable and treatable tragedy. Obstetric fistula overwhelmingly results from obstructed labor, which occurs in cases of cephalopelvic disproportion and malpresentation. Cephalopelvic disproportion often complicates deliveries in young, primiparous women of low gynecologic age. Social factors, including young age at marriage and malnutrition of girl children, can also contribute to cephalopelvic disproportion. These social etiologies must be addressed by prevention campaigns. Direct prevention of fistula can occur during delivery when skilled providers identify women and girls at risk for obstetric fistula and link them with innovative interventions, such as Fistula Prevention Centers, through which they can more readily access emergency obstetric care, and by setting strict time limits for laboring at home without progress. Community-based programs, such as the Tostan program in West Africa, use social education to prevent fistula. Moreover, effective surgical techniques for fistula repair are available in some settings and should be expanded to reach those in need. Midwives can play a key role in the prevention and treatment of this tragic obstetric complication.