What is a Fistula? The most devastating of all childbirth injuries An obstetric fistula develops when the blood supply to the tissues of the vagina and bladder (and/or rectum) is cut off during prolonged, obstructed labour. The tissues die and a hole forms through which urine and/or faeces pass uncontrollably. Women who develop fistulae are often abandoned by their husbands, rejected by their communities and forced to live an isolated existence. More than two million women live with fistula Eradicated in the “developed” world at the end of the 19th century when caesarean section became widely available, obstetric fistula continues to plague women throughout the developing world. It is estimated that there are 100,000 new fistula cases each year, but the capacity to treat fistula is only around 6,500 per year. The United Nations Population fund (UNFPA) estimates the world’s population of fistula sufferers at more than two million. Nerve damage and psychological trauma The WHO has called fistula “the single most dramatic aftermath of neglected childbirth”. In addition to incontinence, a fistula victim may also have nerve damage affecting their ankles and feet. If a woman lies on her mat for a prolonged period of time, waiting for the urine to dry, she may also develop contractions of the joints of her legs, as her muscles and tendons shorten from lack of use, and be unable to walk. Fistula victims also suffer profound psychological trauma resulting from their utter loss of status and dignity.