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Zara of Madagascar was just 15 when she delivered her first baby.

Madina of Somalia was 17. And Sah Sin of Cambodia was in her 20s.

After hours or days of obstructed labor, all three women gave birth to stillborn babies. But their heartbreak wouldn’t end there.

All three also suffered for years—in some cases, decades—from obstetric fistula, a devastating medical condition that leaves women with a hole in their birth canal, leading to chronic incontinence as well as ulcerations, kidney disease and nerve damage in the legs.

Early Marriage in Ethiopia

Yekaba, 15, rests in the hospital after finally giving birth to a baby boy in Bahir Dar, Amhara Region, Ethiopia on May 19, 2007. She had been in labor for three days with her first born and developed fistula. Photo © 2007 Stephanie Sinclair / VII.

At least 2 million women in Africa, Asia and the Arab region are living with obstetric fistula. And because they often can’t control their bowels, the women face social repercussions as well: Many report being abandoned by husbands, shunned by extended family members and ostracized by their communities.

It doesn’t have to be that way.

The condition is treatable—and more importantly, preventable. In 2003, the UNFPA launched its Campaign to End Fistula, which takes a three-pronged approach to wiping out a condition that largely affects poor women in developing nations where medical services may be inadequate.

First, the campaign focuses on preventing obstetric fistula by increasing access to family planning and quality health care, particularly in impoverished regions. In developing countries, only about 58 percent of all deliveries are attended by a skilled health care provider; in some places, that number drops to 10 percent, vastly increasing the risk to mother and baby of injury or death should any medical emergency arrive. Training birth attendants and funding emergency obstetric care are key facets of the campaign. In addition, having children before the pelvis is fully developed is a contributing factor—as are malnutrition and small stature—so empowering girls to delay marriage is also important to preventing the malady.

Second, the campaign is committed to treating patients—like Zara, Madina and Sah Sin—who suffer from obstetric fistula by training doctors to perform operations and supporting clinics where women receive care. The average cost of the treatment, which includes surgery, follow-up care and emotional support, runs about $300. That is often out of reach for patients, so UNFPA and its partner agencies cover the expense.

Last, the campaign provides emotional, economic and social support for women recovering from treatment. Many have endured the physical pain and social stigma of the condition for so long that simply repairing the hole isn’t enough. Through the campaign, women receive counseling and skills training so they can reclaim their lives and contribute to their communities. The campaign also reaches out to the communities where these women live, to explain the condition and reduce the stigma associated with it.

Early Marriage in Ethiopia

Young women recover from fistula surgery at the The Addis Ababa Fistula Hospital in Addis Ababa, Ethiopia on May 30, 2007. Photo © 2007 Stephanie Sinclair / VII.

After 10 years, the Campaign to End Fistula boasts a presence in 50 countries. During that time, thousands of health care providers have received training in fistula treatment, increasing the chances that women, if afflicted, can be healed. You can see a map highlighting more than 150 health facilities providing fistula repair surgeries in 40 countries here.

In fact, more than 27,000 women have received treatment through the UNFPA’s efforts. Many of them have gone on to become ambassadors in their own communities, advocating for better maternal health care, supporting women and girls at risk of developing the condition and letting victims know they’re not alone.

Still, estimates indicate that between 50,000 and 100,000 new cases of obstetric fistula occur each year. And those are only the cases that are reported.

The campaign’s goal—in line with the UNFPA’s mandate to promote reproductive health rights and gender equality—is to marshal the efforts of policymakers, health professionals and the general public to shrink that number to zero.

In wealthier nations, obstetric fistula is virtually nonexistent. It should be that way everywhere.

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