New Research Highlights Pathways to Prevent Obstetric Fistula in Low-Income Countries

By Tosin Clegg

As global health institutions intensify efforts to address preventable maternal health conditions in low- and middle-income countries, new research emerging from the University of North Carolina’s Gillings School of Global Public Health has drawn renewed attention to obstetric fistula and the urgent need for prevention-focused interventions.

Obstetric fistula, a childbirth-related injury caused largely by prolonged obstructed labour, continues to affect thousands of women across Sub-Saharan Africa and other low-resource settings. Health experts have long identified the condition as both preventable and indicative of broader systemic gaps in maternal healthcare access, skilled birth attendance, and timely obstetric care.

A recently completed systematic review conducted by researchers at the Gillings School of Global Public Health examined preventive interventions aimed at reducing the incidence of obstetric fistula in low-income and middle-income countries. The study assessed existing evidence on community-based strategies, health system strengthening, and maternal health service delivery models that have shown potential in preventing the condition.

The research forms part of a growing body of work within global public health institutions focused on shifting the response to obstetric fistula from treatment to prevention. Experts note that while surgical repair remains essential for affected women, long-term reduction in prevalence depends largely on preventive measures, including improved access to antenatal care, emergency obstetric services, and skilled birth attendance.

Dr. Maureen Ezechukwu, a Nigerian physician and public health researcher who participated in the review as part of her Master of Public Health training in Maternal, Child and Family Health, contributed to the analysis and synthesis of evidence drawn from multiple low-resource settings. The work was supervised by faculty at the Gillings School of Global Public Health and completed in May 2020.

According to the researchers, the findings highlight the importance of strengthening primary healthcare systems and addressing socio-economic barriers that delay access to maternal health services. Community education, referral systems, and health worker training were identified as recurring components of effective preventive approaches across different regions.

Commenting on the broader implications of the research, Dr.Ezechukwu noted that prevention remains central to reducing maternal morbidity. “Obstetric fistula is largely preventable when women have access to timely and quality maternal healthcare,” she said. “Evidence consistently shows that early intervention, skilled care during childbirth, and functional referral systems can significantly reduce the risk.”

Public health specialists have welcomed the growing focus on prevention, particularly as countries work to meet maternal health targets under global development frameworks, including the Sustainable Development Goals. Nigeria, which bears a substantial burden of maternal health challenges, continues to prioritise strategies aimed at improving maternal outcomes through health system reforms and community-based interventions.

The findings from the systematic review add to ongoing policy discussions on how best to allocate resources toward maternal health prevention, especially in settings where access to emergency obstetric care remains limited. Researchers argue that evidence-based preventive strategies are essential to complement existing treatment-focused programmes.

As global attention increasingly turns toward maternal health equity, contributions from researchers and clinicians with experience in low-resource settings are seen as critical to shaping practical and context-specific solutions. Studies such as this underscore the role of academic research in informing policies that address longstanding public health challenges affecting women in vulnerable communities.