This commentary, published in The Lancet Global Health on the occasion of the International Day to End Obstetric Fistula on 23 May, underscores the critical role of universal access to skilled care at birth – including EmONC and safe surgery – for ending preventable maternal and newborn mortality and morbidity (including obstetric fistula and stillbirths). Drawing upon recommendations from the Lancet Commission on High Quality Health Systems in the SDG Era and the Lancet Commission on Global Surgery, it emphasizes that ensuring all women and girls in need receive timely, high quality, life-saving obstetric surgery (whether Cesarean section or fistula repair) is a fundamental human rights issue and a key strategy for achieving the Sustainable Development Goals.