Programs Obstetric Fistula Care

A Preventable Tragedy


In countries where access to high-quality obstetric care is a challenge due to factors such as economic and medical infrastructure constraints, having a baby presents multiple risks. One such risk is the development of an obstetric fistula, a complication of childbirth resulting in damage to pelvic and reproductive organs and constant urinary or fecal incontinence. The problem occurs in low-resource settings because of prolonged labors and lack of access to timely cesarean delivery for obstructed labor. It is estimated that over 2 million women in Africa live with an obstetric fistula, even though it is 100% preventable.

Due to the odor and leaking, women with obstetric fistulas often withdraw from their usual social lives, either from self-shame or external ostracism; most are divorced by their spouses. About 90% of obstetric fistula cases are accompanied by stillbirth of the baby that caused the fistula, and many women struggle to conceive again. Given these complications, it is often difficult for women to forge new relationships.

Repairing Bodies and Lives in Malawi


In Malawi alone, it is estimated that 20,000 women are living with an obstetric fistula. Texas Children’s Global Women’s Health has partnered with the Freedom from Fistula Foundation to tackle this number.

At the Freedom from Fistula (FFF) Care Centre in Lilongwe, corrective surgery helps women resume normal lives. The fistula team, led by Dr. Jeffrey Wilkinson, has performed more than 1,900 fistula repair surgeries with a 90% success rate.

Training for Repair and Prevention


Global Women’s Health also partners with the Malawi Ministry of Health to increase the number of skilled individuals to prevent more fistula cases and to repair those that already exist. Using a network of expert fistula surgeons, the obstetric fistula training program includes electronic lectures, current literature on obstetric fistula, surgical and medical care goals, and face-to-face feedback through mentorship. The aim of the program is to increase the number of high-quality fistula surgeons in Malawi and other countries where there are many women with obstetric fistula.

Additionally, through training specialist obstetrician-gynecologists and providing support for the maternity ward and operating rooms at the Area 25 Health Centre, many more women will receive the care they need to prevent problems like a fistula.

In 2020, Texas Children’s Global Women’s Health partnered with the International Federation of Obstetrics and Gynecology (FIGO) to train fistula surgeons on a large scale. The FIGO Fistula Surgery Training Initiative is training fistula surgeons and multidisciplinary teams to provide life-transforming care to significantly greater numbers of women suffering from this debilitating condition.

This program is dedicated to building the capacities of local fistula surgeons –FIGO Fellows- and teams over time. This takes place with training placements in acknowledged training centres, followed by intermittent coaching visits from FIGO Trainers in Fellows’ home facilities, using the FIGO and partners Global Competency-Based Fistula Surgery Training Manual, the world’s first standardized, evidence-based tool to train fistula surgeons.

As of now, there are 62 surgeons from 22 affected countries enrolled on the program, who have collectively provided more than 10,000 fistula repair operations. FIGO is committed to expanding this initiative, to reach significantly more women in the future.

Leading Through Innovation & Improvement


The Fistula Care Centre in Malawi is a Centre of Excellence for obstetric fistula care and lends itself to long-term follow-up of women with fistulas. Therefore, an extensive database is used to keep records of patient outcomes, surgical techniques, and medical care.

This has led to dozens of published peer-reviewed articles and paradigm-shifting research.

Through collaboration with Houston-based plastic surgeons, Dr. Wilkinson and team are offering improved techniques for patients with the most complicated fistulas and finding improved outcomes compared to traditional surgery. It is through the support of an academic center that continues pushing innovation for the improvement of care of women with obstetric fistula.

Texas Children’s Global Health Network leads efforts that advance healthcare equity through innovative collaboration in care, education and research globally.

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