This is why rich settings where such treatment, namely Caesarean section, and emergency obstetric care are available have all but eliminated fistula.
Without urgent, high-quality medical assistance, such a difficult labour can last for days, with the constant pressure of the baby’s head cutting off blood supply in the pelvis and leaving a hole after the dead tissue falls away, resulting in fistula or worse, possibly death. Obstructed labour is one of the leading causes of maternal death worldwide, and 90 per cent of fistula cases end in stillbirth.
Some female genital fistulas are caused during gynaecological procedures (e.g. hysterectomy) and Caesarean-sections with substandard health care and inadequate surgical skills training/competence. These are called iatrogenic fistulas. Traumatic fistulas are caused by sexual violence, especially in conflict areas; the destruction of the vagina is considered a war injury.
On a deeper level, fistula implies a failure of health systems to meet the needs of the most disadvantaged women and girls, as well as social injustice and gender and socioeconomic inequality, lack of education - all hinder the empowerment of women and girls and their right to bodily autonomy.
As a preventable condition that still afflicts half a million women and girls, it is a violation of human rights and a tragic example of gross inequities reflecting the marginalization of those affected.