Fistula provides a critical lens onto the health and social systems that promote - or limit - the capacity of girls and women to achieve well-being. Underlying the medical presentation of fistula are its true determinants: poverty, which constrains families from accessing basic health care services; resource limitations, which undermine the capacity of health care workers to deliver high-quality care; insufficient investment in infrastructure, which makes transport to a health care facility nearly impossible, particularly in times of emergency; insufficient access to information and knowledge about maternal health and pregnancy-related emergencies; inadequate decision-making status for girls and women; and a continuing acceptance of women dying in childbirth or surviving with unspeakable consequences.