Obstetric Fistula: Prevention Is Indispensable

Obstetric fistula is an abnormal opening (hole) between a woman’s genital and urinary tract or rectum, caused by prolonged, obstructed labour without timely medical intervention. It leaves women and girls unable to control the discharge of urine, faeces, or both, and often results in chronic medical problems, depression, social isolation, and deepening poverty. Estimates suggest that around half a million women and girls across sub-Saharan Africa, Asia, the Arab States, Latin America, and the Caribbean are living with fistula. Yet the condition is almost entirely preventable. The gap between its preventability and its persistence reveals weaknesses in health systems, education, and the protection of girls’ rights. Tomorrow, May 23, 2026, Cameroon will join the international community to observe the International Day to End Obstetric Fistula, drawing attention to one of childbirth’s most serious and tragic injuries. According to the World Health Organisation, at least 500,000 women worldwide live with untreated fistula, with 50,000 to 100,000 new cases developing each year. In Cameroon, it remains a significant public health challenge, with an estimated 18,000 to 21,000 women affected and approximately 2,000 new cases annually. Hospital data and UNFPA report indicate hundreds of new cases each year, the majority in the Far North, North, and Adamawa Regions. Behind these figures are individuals whose lives are abruptly altered: often adolescents who endure not only physical suffering but also profound social rejection. Preventing obstetric fistula is not merely preferable; it is indispensable. Surgical repair has transformed the lives of thousands, but it addresses the consequence rather than the cause. The medical, economic, and human costs of treatment are substantial, and the capacity to provide it remains limited where the need is greatest. Prevention, through improved access to skilled birth attendance, emergency obstetric care, education, and delayed childbearing, offers a sustainable path to eliminating obstetric fistula. Cameroon’s maternal health profile places it among the countries where obstetric fistula persists even if it is a preventable condition. The 2018 Demographic and Health Survey reported a maternal mortality ratio of 529 per 100,000 live births and a skilled birth attendance rate of 64 per cent nationally. These averages conceal sharp regional disparities. In the Far North, only 37 per cent of births are attended by skilled personnel, and adolescent fertility stands at 166 births per 1,000 women aged 15– 19, compared with 72 nationally. Hospital-based studies provide the clearest picture of the fistula burden. The Yaounde Gynaeco-Obstetric and Paediatric Hospital, along with Regional hospitals in Maroua and Garoua, report 200–300 new cases annually presenting for repair. UNFPA estimates that the true incidence is higher, as many women never reach care due to distance, cost, and stigma. The Far North, North, and Adamawa Regions account for most cases, reflecting a combination of early marriage, limited access to emergency obstetric care, and weak referral systems. In these areas, a woman in obstructed labour may travel for hours on poor roads before reaching a facility capable of performing a caesarean section. Risk factors in the country mirror global patterns but are intensified by local context. Early marriage remains prevalent, with 32 per cent of women aged 20–24 married before the age of 18. Early pregnancy in an adolescent whose pelvis is not fully developed increases the risk of obstructed labour. Security challenges in the Far North and Anglophone Regions disrupt services and displace populations, further restricting access to routine and emergency care. The physical symptoms of obstetric fistula are immediate and relentless. The delay between clinical cure and social recovery reinforces the argument that preventing the injury avoids a cascade of harms that surgery alone cannot reverse. Despite a clear governmental agenda to end obstetric fistula, implementation faces persistent barriers. The priority must be to reduce the incidence of obstructed labour itself. Key measures include delaying the age of first marriage and childbirth, improving nutrition to reduce stunting, and expanding girls’ education. Each of these interventions addresses an underlying determinant of maternal risk. A 2011 law sets the minimum age of marriage at 18, but enforcement is weak in rural areas where customary law prevails. Strengthening enforcement requires working with traditional leaders, religious au...