Bujumbura, Burundi — "During my contractions, my mother-in-law and my own mother refused to let me go to the health centre to give birth," Gloriose Mbonimpa told UNFPA, the United Nations sexual and reproductive health agency. "I felt death was approaching."
Isolated from the medical care she needed, Ms. Mbonimpa shouted to her neighbours for help. They tried to take her to the local medical centre, but it was too late; she gave birth on the way, delivering a stillborn baby and suffering an obstetric fistula in the process.
Obstetric fistulas are childbirth injuries that result mainly from prolonged, obstructed labour. Around the world, these injuries affect nearly half a million women and girls - especially those lacking access to timely, high-quality medical support. In Burundi, where Ms. Mbonimpa lives, it is estimated that women and girls sustain up to 750 new fistula injuries every year.
The consequences can be devastating. Fistula survivors are often forced to deal with traumatic physical ailments, including incontinence, social ostracism and extreme poverty.
"Women in the maternity ward asked that I be isolated because I wet the bed. In addition to the pain of having lost my baby, I didn't understand what was happening to me," Donavine Ndayikengurukiye, another fistula survivor, told UNFPA.
Meanwhile, Ms. Mbonimpa's husband abandoned her for four years following her injury. Ashamed, she also lied to health-care providers about her condition. "I was giving off unbearable odours," she said. "No one deserves to experience this."
Once ashamed, now an advocate
Fistulas can be fixed. Yet research shows many survivors are unaware that surgery can help heal their injuries.
Initially, Ms. Ndayikengurukiye was one of them. But "learning that I had the chance to recover was the best news of my life," she told UNFPA.
In Burundi, just one health facility - the Urumuri Centre in the country's capital, Bujumbura - is equipped to handle fistula cases. Between 2010 and 2023, approximately 3,000 women underwent repair surgeries there.
Ms. Mbonimpa was one of them. In 2022, she sought treatment at the centre during a UNFPA-supported campaign that offered fistula survivors access to free health care.
For two decades she had lived in isolation, humiliated by her condition. But since recovering she has made a promise: To dedicate the next two to raising awareness about obstetric fistula so that no other woman or girl in her community has to suffer the same experience.
Ending fistula for ever and for all
While surgery offers survivors the opportunity to heal, the best way to end the harm fistulas cause women and girls is to prevent them from occurring in the first place.
The prevalence of obstetric fistula follows patterns of inequality: Almost absent from high-income countries, the condition mainly affects women and girls in the Arab States region, Asia, Latin America and the Caribbean and sub-Saharan Africa.
"Obstetric fistula is a tragic result of our failure to protect the reproductive rights of the most vulnerable and excluded women and girls," said UNFPA Executive Director Dr. Natalia Kanem.
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Adolescent girls can be especially vulnerable to the injury, as their pelvises may not have developed sufficiently for childbearing, putting them at risk of obstructed labour.
"I think I got this [fistula] because I gave birth when I was very young," Ms. Ndayikengurukiye told UNFPA.
Twenty-three years old and now fistula-free, Ms. Ndayikengurukiye is mother to a little girl whose birth took place one year following her recovery. Since then, she and her husband have embraced family planning.
"My husband and I chose family planning so that my body could rest from the risk of having another obstetric fistula, and to wait for our little girl to grow up a little bit," she said.
