May 23 is International Day to End Obstetric Fistula. For millions of girls and women across Africa, the trauma of obstetric fistula lasts longer than a day. It’s a daily reality lived in silence, cloaked in pain, shame and a reminder of how healthcare systems fail girls, women and gender diverse people through not prioritising care. According to the 2024 UNFPA report, “nearly 500,000 women and girls worldwide, with thousands of new cases emerging each year. Sub-Saharan Africa has 50% of the estimated global burden of obstetric fistula, and West and Central Africa is one of the sub-regions with the highest rate.”
Obstetric fistula is a hole between the birth canal and bladder or rectum, caused by persistent, complicated labour without appropriate medical intervention. But the definition neglects to reveal a deeper truth … fistula is a consequence of systemic failures deep-rooted in poverty, neglect, patriarchy, and power and violent health systems.
Obstetric fistula is not just an illness. It is a consequence of intersecting forms of violence. And to end it, we have to raise awareness about it, end gendered inequalities that make girls and women victims, repair crumbling healthcare systems, make healthcare accessible, and collectively work together to end poverty.
Child Marriage and the Betrayal of Childhood
Let’s begin with the culture of violating girls’ and women’s bodies and child brides. Girls who are married off when they are not emotionally or physically ready for pregnancy or marriage. Girls are robbed of their childhood in the name of tradition, for dowry, or as a means of survival when girls become commodities. This speaks to the commodification of girls, which is rooted in patriarchy.
Child marriage is framed as a cultural practice; however, from a feminist perspective, it is violence. It is a form of violence that communicates to girls and women that their bodies do not belong to them and that they are not worth protecting or entitled to good health. It communicates that their bodies belong to men, their families, and are commodities that can be used for transactions. When girls are forced into marriage, the chances of them getting pregnant when they are too young are high, which in turn also makes them vulnerable to complications during pregnancy and childbirth, including fistula.
The violence of child marriage is not just physical. It is emotional, psychological and generational.
The Violence of Poverty
It is easy to treat poverty like an environment in which it is most likely to happen; however, it is more than that – it is structural violence. When girls or women in impoverished communities have to commute for hours to reach a healthcare facility which is likely to be under-staffed and resourced, when their family can not afford to give them money for transport or basic medical care, when hospitals do not have trained midwives, resources or electricity — that is not a coincidence. It is the outcome of economic systems that cheapen the lives of poor people.
Fistula seldom occurs in women with power and the privilege of access to adequate healthcare. It happens to those whose lives are devalued and treated as being disposable. A feminist response does not only call for surgical interventions, it demands that we ask why anyone is giving birth without care in the first place and interrogate the intersecting drivers of the lack of access.
Access to healthcare is not just about there being healthcare facilities. It is about whether girls and women can reach the facilities, whether there are trained staff, inclusive and affirming care, and the resources that make treatment and care possible. In many parts of Africa, people giving birth are told to “push” through labour because facilities are not equipped with the capacity to respond to emergencies. Some are forced to give birth at home or with untrained support, not out of choice, but out of necessity, because there is no other option.
Ending fistula means resourcing healthcare facilities in meaningful and real ways, not just on paper, in ways that respond to real-life scenarios. It means ensuring there are trained midwives who are affirming and inclusive, funding healthcare facilities in under-resourced communities, training healthcare providers, and ensuring that sexual and reproductive health services are not a privilege but a right.
Where is the SRHR Education?
There are deep implications that are a consequence of the absence of information — another form of violence. In many communities, girls and women do not have access to information and opportunities to learn about their bodies and rights. They do not know what pregnancy means, how to prevent unintended pregnancies, what kind of care is required during pregnancy, how labour works, and/or how to protect themselves. When sexuality is taboo and reproductive health is not discussed, women and girls are left vulnerable — not only to pregnancy, but to isolation, trauma and fistula.
Comprehensive sexuality education is not just about preventing disease. It is about making sure people have the information they need to advocate for themselves, understand consent, know when something is wrong, and to ask for help when they need it. It allows them to make informed choices.
Shame and Silencing Keep Fistula Alive
So many girls and women live with fistula for years and do not say anything out of fear and/or shame, suffering in silence, cut off from their communities, made to feel dirty, unworthy of love or dignity. That shame does not come from the condition itself. It comes from a world that sees poor girls and women as burdens instead of people worthy of dignity.
To end fistula, we also need to unpack the shame associated with it. We must support survivors, create safe spaces and support systems for them to speak, feel seen, and loved. Healing is not limited to surgical interventions. It’s about restoring dignity and safeguarding human rights.
What a Feminist Response Looks Like
A feminist response to fistula is not limited to repair. It is about dignity, justice and prevention. It means:
– Investing in public health systems, ending barriers to access and reaching everyone.
– Ending child marriage.
– Ending female genital mutilation.
– Providing comprehensive sexuality education.
– Promoting community-led interventions.
– Training healthcare workers to treat every patient with compassion and respect.
– Listening to survivors and funding their leadership.
This is not charity. This is justice.
Obstetric fistula is avoidable. However, many women are still forced to live with it because the structures that are supposed to protect them have failed. On this International Day to End Obstetric Fistula, we honour their stories not with pity, but with action.