The Campaign to End Fistula is an international effort that currently covers some 45 countries in sub-Saharan Africa, South Asia and some Arab States. The United Nations Population Fund (UNFPA) launched the campaign in 2003 in response to an emerging body of evidence on the negative impact of obstetric fistula on women's lives. Obstetric fistula is a maternal injury that, according to UNFPA, has been largely neglected, despite the severe impact it has on the lives of girls and women. It is usually caused by several days of obstructed labour, without timely medical intervention (a Caesarean section to relieve the pressure). The baby usually dies, and the woman is left with chronic incontinence. Because of the inability to control her urine and the associated odour, the woman is often abandoned or neglected by her husband and family and ostracised by her community.

UNFPA is motivated by the belief that fistula is an issue of rights and equality and an effective entry point into strengthening women's reproductive health and furthering gender equity, helping support achievement of the Millennium Development Goals. To that end, the Campaign includes interventions to prevent fistula from occurring, to treat women who are affected, and to help women who have undergone treatment return to full and productive lives, with the ultimate goal of making fistula as rare in the developing world as it is in industrialised countries today.
Communication Strategies: 

The Campaign works in three key areas: prevention, treatment, and support to help women who have been repaired return to their communities. And it works in three phases: assessing needs, planning interventions, and implementing national strategies.

Key strategies to address fistula:

  • Provide access to adequate medical care for all pregnant women and emergency obstetric care for all who develop complications.
  • Increase access to education and family planning services for women and men.
  • Postpone pregnancy for young girls until they are physically mature.
  • Improve girls' nutrition to prevent stunted growth (which can leave the mother's pelvis small in relation to the baby's head) and to minimise the risk of complications during childbirth.
  • Repair physical damage through medical intervention and emotional damage through counselling.

A website for the global Campaign to End Fistula was launched in October 2004. It features a three-minute web film, an interactive map highlighting Campaign progress, a photo gallery and testimonies of fistula patients and the doctors who care for them. The Campaign gained momentum and international attention when Dr. Catherine Hamlin, one of the Campaign's champions, went on the Oprah Winfrey show and introduced the issue of obstetric fistula to millions of people all over the world. In addition, the Campaign has recruited international singer/songwriter and L'Oreal cosmetics model Natalie Imbruglia as a celebrity spokesperson for the Campaign to End Fistula. Imbruglia hopes to use her profile to raise awareness of this little-known childbearing injury, particularly in her native Australia and the UK. The ad agency Rainey Kelly Campbell and Roalfe/Y&R signed on to the Campaign in November 2004, lending its creative services to the cause on a pro bono basis. On June 27 2006, UNFPA and RKCR/Y&R launched a month-long advertising campaign in London to raise awareness and funding for obstetric fistula. This UK drive is intended to inform, educate and leverage support
from the British public for this issue. Visit the Fistula Campaign website to view a 60-second public service announcement and other ad materials.

Richard Branson, a British Billionaire, and Virgin Unite,
the charitable organisation of Branson's Virgin Management Corporation, have also joined with the Campaign, contributing to the recent "Fistula Fortnight" initiative in Nigeria. On February 21 2005, UNFPA and partners launched an unprecedented surgical effort to address the issue of obstetric fistula at four sites in northern Nigeria. Over the course of two weeks, volunteer doctors from the United States and United Kingdom joined forces with Nigerian surgeons to treat 545 women with fistula and to train dozens of Nigerian doctors, nurses and social workers in surgery and post-operative care. The "Fistula Fortnight" was covered by local press and international media, including AP, Reuters and Voice of America.

The Campaign website contains press and media resources that help to disseminate information about this problem and raise awareness. Lobbying of governments and donors by UNFPA has also led to an increased recognition by the health services in target countries of the need to provide obstetric services and rehabilitative surgery for afflicted women.

Development Issues: 

Maternal Health, Gender, Women, Childbirth.

Key Points: 


  • The World Health Organisation estimates that more than two million women are living with fistula in developing countries; an additional 50,000 to 100,000 new cases occur each year. These figures are based on the number of women seeking treatment, and are likely to be gross underestimates. In areas with high maternal mortality, fistula may occur at a rate of two to three cases per 1,000 pregnancies.
  • About 15 per cent of all pregnancies will result in complications that require emergency medical intervention.
  • Only 58 per cent of women in developing countries deliver with the assistance of a professional (a midwife or doctor). Only 40 per cent give birth in a hospital or health centre.
  • The average cost of fistula repair surgery is $300, well beyond the reach of most women with the condition.
  • The success rate of fistula repair for experienced surgeons can be as high as 90 per cent. After successful treatment, most women can resume full lives.
  • Obstetric fistula is preventable and treatable.
  • Prevention is the key to ending fistula.
Partner Text: 

UNFPA, Addis Ababa Fistula Hospital, Engender Health, Equilibres & Populations, International Confederation of Midwives (ICM), International Federation of Gynaecology and Obstetrics (FIGO), Population Council, The Worldwide Fistula Fund, United Nations Foundation, Virgin Unite, Women's Dignity Project, World Health Organisation (WHO), Voluntary Service Overseas.


Fistula Campaign website; and emails from Julie Weber to The Communication Initiative on June 29 and July 19 2006.