Imagine bringing a child into the world and walking away not with joy but with shame, pain, and isolation. Sadly, that is the reality for millions of girls and women in underdeveloped countries. They have often been abandoned by their husbands and excluded by their families and communities.
While obstetric fistula is seen as a public health issue, it is deeply rooted in systemic failures. The fight for Fistula Prevention must include stronger policies to protect maternal health rights. This year’s International Day to End Obstetric Fistula theme is ‘Leaving No One Behind: Let’s End Fistula Now.’ In this article, we’ll examine the link between maternal health rights and Fistula Prevention strategies that can transform women’s lives.
What is an Obstetric Fistula?
Obstetric fistula is a childbirth injury that results from prolonged obstructed labour. When a woman does not receive timely medical intervention, the pressure from the baby’s head can cut off blood flow to surrounding tissues. This trauma creates a hole (fistula) between the vagina and bladder or rectum.
More than 2 million women globally live with untreated obstetric fistula. 50,000 to 100,000 new cases occur yearly, mainly in Asia and sub-Saharan Africa. This condition is often preventable and almost always treatable. Yet, Nigeria contributes 40% of the global obstetric fistula burden. More than 400,000 women remain untreated, and 13,000 new cases occur annually.
These numbers are more than statistics. They represent real women whose fundamental rights to health and dignity have been violated.
Maternal Health Rights and Fistula Prevention
Maternal health should not be a luxury. Every woman has the right to:
- Access timely and quality prenatal, postnatal, and obstetric care before, during, and after childbirth. Article 12 of the International Covenant on Economic, Social, and Cultural Rights (ICESCR) guarantees the right to the highest attainable physical and mental health standard.
- Make informed decisions about their reproductive health. Article 16(e) of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) ensures women make autonomous choices about family planning, including the number and spacing of their children. It also gives them access to the necessary information, education, and means to exercise these rights.
- Be protected from harmful traditional practices and systemic neglect. Article 24(3) of the Convention on the Rights of the Child (CRC) obligates states to eliminate traditional practices prejudicial to health and well-being.
In 2003, the United Nations Population Fund (UNFPA) and its partners started a global campaign to end fistula. The campaign aims to make fistula rare through surgical treatment and patient reintegration. Over 50 countries, including Nigeria, have benefited from this initiative. Medical personnel have also received training with support from the Maternal Health Thematic Fund.
The Role of Government Neglect In The Prevalence of Obstetric Fistula
Women in low-income communities are the most vulnerable. Not because they lack resilience but because the system repeatedly fails them.
Some of the loopholes in the healthcare system include:
- Lack of Budgetary Commitment
African Union countries signed the Abuja Declaration of 2001, pledging to allocate at least 15% of their annual budgets to health. Despite this commitment, Nigeria’s allocation to its health sector has hovered around 5–6% for years. Maternal health receives only a fraction of these limited resources.
- Limited Access to Emergency Obstetric Care
The WHO recommends a doctor-to-population ratio of 1:600 as a benchmark for ensuring adequate healthcare access. However, Nigeria has approximately one doctor per 5,000 people. In rural areas, the ratio worsens to 1 per 20,000. Similarly, there is one midwife per 1,000 live births, compared to the recommended 6 per 1,000. The delay or absence of proper care results in life-altering outcomes.
- Healthcare Infrastructure Gaps
Women in rural areas live far from hospitals that can handle obstetric emergencies. Transportation in these areas is difficult and time-consuming due to the poor road system. The lack of reliable ambulance services implies that women have to rely on less efficient means of transportation.
- Weak Implementation of Maternal Health Policies
Nigeria’s policies look good on paper. However, poor monitoring, corruption, and a lack of political will prevent them from being effective.
Legal Accountability for Fistula Prevention: What Governments Must Do
Governments are not just morally responsible. They are legally obligated to protect maternal health and prevent conditions like obstetric fistula.
Domestic Policies
Health policies that apply in Nigeria include:
- Constitutional Rights.
Section 17(3)(d) of Nigeria’s Constitution mandates the state to provide adequate medical facilities for all. Yet, this remains unfulfilled for many women.
- National Health Act of 2014
The Act establishes a legal framework for quality healthcare in the National Health System. It defines stakeholder responsibilities, sets service standards, and establishes the Basic Health Care Provision Fund. However, enforcement is still weak. To make matters worse, many healthcare facilities do not meet the basic standards required by the Act.
- Revised National Health Policy (2016).
The health policy emphasizes primary healthcare, community-based services, and preventive measures for Nigerians. It aims to provide health care for all through Universal Health Coverage and financial risk protection via health insurance. It is not limited to maternal health but extends to newborns, children, and adolescents.
- The National Strategic Framework for the Elimination of Obstetric Fistula (2022–2026).
The Federal Ministry of Health and Social Welfare developed a framework to focus on prevention, treatment, and rehabilitation for women affected by obstetric fistula. The WHO notes that priority areas include leadership, governance, research, and monitoring and evaluation.
Governments are accountable even if the violation results from omission rather than direct action.
Transforming Fistula Prevention: Policy Recommendations and Necessary Changes
To prevent fistula, we need a multi-layered approach. Here are key legal and policy strategies that can help address the crisis:
- Increase Healthcare Budget Allocation.
Meet and surpass the 15% health budget target pledged in the Abuja Declaration.
- Establish and Equip More Fistula Centres.
Create accessible, well-staffed fistula repair centres in rural areas.
- Train and Deploy Skilled Birth Attendants.
Focus on training midwives and doctors, especially in underserved communities.
- Strengthen Accountability Mechanisms.
Ensure that healthcare providers and government officials are liable for negligence or corruption.
- Amend and Enforce Maternal Health Laws.
Prioritise laws that protect women’s health rights and provide a framework for legal redress.
- Include Fistula in NHIS Coverage.
The National Health Insurance Authority (NHIA) launched the Fistula-Free Programme in June 2024. The initiative aims to prevent fistula and treat it as part of Nigeria’s National Health Insurance Scheme. Since its inception, the program has provided free care to over 1,629 women across 42 facilities nationwide. The comprehensive care includes surgeries, feeding, transportation, and post-care follow-up.
- Launch Community Awareness Campaigns.
Invest in health education, especially for rural communities. Teach about maternal rights, safe childbirth, and early access to proper care.
- Integrate Reproductive Health into Education.
Start from the grassroots. Include maternal health and rights education in schools.
Grassroots to the Rescue: The Role of Society and the Law
While governments stall, NGOs, community leaders, and local clinics continue to bridge the gap. Healthcare advocates and women’s rights gatherings use every tool to demand justice and equity.
Programs like the Fistula Care Initiative (FCI) have changed lives. So far, FCI has supported over 300 repair surgeries and reintegrated survivors into their communities. Community-driven solutions are vital. However, they need baking from law and policy.
Her Life, Her Right
Obstetric fistula is more than a medical condition. It is a public health issue that serves as a sign of deeply rooted systemic neglect. Every avoided case is a woman saved from pain and a step toward a culture that values women’s lives and rights. Women should not just survive but thrive after childbirth.
We remain committed to supporting legal reforms that uphold maternal health rights and hold the system accountable.
If you found this article informative, share it to raise awareness about maternal health rights. You can also read our article on Female Reproductive Health: The Need for Medical Consent and Accessible Healthcare.