Global, regional and national estimates of obstetric fistula prevalence.

introductionThe UN General Assembly in 2018 passed a resolution to eliminate obstetric fistula within a decade. Because the prevalence of obstetric fistula is not known, it is difficult to develop appropriate national and global health strategies to prevent, treat and eliminate the condition. We estimate the prevalence of obstetric fistula in 55 countries targeted by the UNFPA-led global Campaign to End Fistula Programme.

methodsWe used data on reported symptoms of obstetric fistula from 31 Demographic and Health Surveys conducted in 22 countries and applied a predictive model to estimate the global, regional and country-level prevalences of current obstetric fistula cases in target countries. Self-reported fistula symptoms are subject to over-reporting and misclassification biases. Using known estimates of clinically diagnostic validation from large population studies, we additionally corrected self-reported obstetric fistula estimates for misclassification errors.

resultsWe estimate the global fistula prevalence of about 457 000 (95% CI 303 000 to 709 000) among women aged 15-64 and about 386 000 (95% CI 256 000 to 599 000) among women of reproductive age (15-49). The obstetric fistula prevalence rate was almost two times higher in the sub-Saharan region (71 per 100 000 women) compared with Asia (36 per 100 000 women).

conclusionThe estimated prevalence of obstetric fistula is substantially lower than the previously cited numbers of 2 million women. The prevalence and incidence rates of obstetric fistula have likely declined over time due to a number of factors. Skilled birth attendance, access to emergency obstetric care and caesarean section deliveries have substantially increased in low- and middle-income countries with a concurrent decline in maternal mortality during the last two decades. The global Campaign to End Fistula, launched in 2003, together with other international efforts, has also targeted improving prevention and treatment of obstetric fistula during this period. This is a preventable and treatable condition, and the global community must mobilise to eliminate this devastating and tragic condition by ensuring that women have access to timely and quality emergency obstetric care, including safe surgical care for caesarean section.