Obstetric fistula is rare in Western countries, thanks to the wide availability of caesarean section, but the potentially devastating childbirth injury continues to affect an estimated two million women throughout the developing world.

This type of fistula arises from ischaemia during prolonged obstructed labour. Fistulas can form between the vagina and bladder or rectum, causing continuous leakage of urine or faeces.

Poverty is the main risk factor for fistula, which the World Health Organization has called “the single most dramatic aftermath of neglected childbirth.” Most women have little or no access to antenatal or obstetric care, and, once injured, nearly all go untreated, although surgery can cure fistulas. Because of the smell of urine and their inability to have children, the women are often cast out from their communities and left to fend for themselves.

There are 100 000 new cases of such fistulas every year worldwide, but only about 6500 are treated. The Addis Ababa Fistula Hospital is now set to open the first of five regional centres in Ethiopia, paid for by fund raising (from charitable trusts in the United States, the United Kingdom, Australia, and Norway), to treat women with fistula and provide emergency obstetric care.

The programme developed by Australians Dr Catherine Hamlin …