Statement by Edward Kallon, the UN Resident and Humanitarian Coordinator for Nigeria, on the occasion of commemorating International Day to End Obstetric Fistula.

Today we lend our voice to a most worthy cause in commemorating the International Day to End Obstetric Fistula. This childbirth-related injury is now unheard of in developed nations, yet 2 million women in the developing world are affected by this life shattering condition. Each year, another ~100,000 women will suffer from obstetric fistula. Nigeria accounts for 40% of all fistula cases globally. Consequently, many Nigerian women and girls are needlessly enduring pain and ostracisation. We wish to let them know that they are not suffering in obscurity nor in perpetuity. 

Obstetric fistula is one of the most serious and tragic childbirth injuries. A hole between the birth canal and bladder and/or rectum is caused by prolonged obstructed labour without access to timely medical treatment. It leaves women permanently incontinent, and often leads to chronic medical problems, depression, and deepening poverty. The social consequences are as devastating as the physical ones because women are often abandoned by their husbands and shunned by their communities. 

In Nigeria, an estimated 150,000 women and girls are afflicted by this debilitating condition, while 13,000 new cases are added annually. The COVID-19 pandemic is expected to cause an increase in instances of fistula due to the pressure on the health system, decreased access to family planning, and a rise in child marriages. 

The good news is that obstetric fistula is both preventable and treatable in nearly all cases. Patients with uncomplicated fistula can undergo a simple surgery that costs $600 per patient. The UNFPA has ably led the global campaign to End Fistula, helping to conduct 121,000 surgeries in 55 countries since 2003, transforming the lives of so many women and girls. 

The UNFPA has two major ongoing projects in Nigeria which support the effort to end fistula. The first is based in Sokoto state and is funded by the Government of Canada. It involves training of health personnel, provision of essential equipment and consumables, establishment of a new treatment centre, provision of free fistula treatment, prevention of early and child marriage, and the promotion and enforcement of anti-GBV laws. The second project is supported by the EU/UN Spotlight Initiative which provides free fistula treatment and other services related to gender-based violence across the country.

But the current scale of response is not commensurate with the burden of suffering across Nigeria - we need to scale up and scale up fast. Less than 2,000 surgical repairs are performed annually here, leaving a huge backlog in untreated fistula that will take decades to clear at the current rate.

Eliminating fistula is a key element of “leaving no-one behind” and the world risks failing to achieve the SDG targets if there is still a woman or girl left in the world who is suffering from fistula and being neglected. In Nigeria, the UN System’s key goal is to support the Government of Nigeria to implement the 2030 Agenda and the SDGs. The UN will also support the government’s Obstetric Fistula Strategic Plan for 2019-2023 which outlines a vision of a fistula free Nigeria. Let’s work together to make that vision a reality. 

The theme of this year’s international day is “Women's rights are human rights! End fistula now!” Fistula is not just a health issue - it is a women’s rights issue. A woman’s right to decide if and when she has children is vital to achieving equality for women and girls. Women need to be fully empowered to make their own decisions about sexual and reproductive health and about contraception. The denial of bodily autonomy is not just a violation of women and girls’ fundamental human rights, but studies show that where women’s decision-making is constrained, higher levels of morbidity (such as obstetric fistula) and mortality result. 

I call on all Nigerians and all stakeholders in society to consider the plight of women and girls affected by obstetric fistula. Today is the day to reaffirm our commitment to ending this dreadful condition and to redouble our efforts. We need to strengthen health systems and maternal medical care, promote women’s rights, empower women and girls with autonomy in their decision-making, increase availability and affordability of fistula treatment, and increase fund allocation, particularly for obstetric fistula prevention, treatment and reintegration services. Let’s provide hope, healing and dignity for all. The time to act is now.

Thank you.