Obstetric fistula is one of the most devastating childbirth injuries a woman can experience, yet it remains widely misunderstood.
At Hamlin Fistula Ethiopia, many women arrive for treatment after years of physical suffering, stigma and social isolation. Misconceptions about what causes fistula — and whether it can be treated — can deepen that suffering and delay care.
To challenge some of the most common myths, we spoke to Dr Betelhem Tadese, a general practitioner at Hamlin’s Addis Ababa Fistula Hospital.
Can a woman who has had obstetric fistula have a baby?
Yes. Many women go on to have children after successful fistula treatment. However, because of the risks involved, Dr Betelhem says women who have previously had fistula are strongly advised to give birth by caesarean section. Former Hamlin patients can return to a Hamlin fistula hospital for a free caesarean birth if they become pregnant again.
Is there no treatment for obstetric fistula?
This is one of the most harmful myths. Obstetric fistula is treatable, and many women can be cured with surgery. Sadly, many of the patients we see have lived with their injury for years before reaching Hamlin. By then, the physical damage is often compounded by deep psychological trauma. That is why women at Hamlin receive counselling as part of the Hamlin Model of Care.
Surgery can repair the injury, but emotional healing often takes longer.
Is obstetric fistula rare and not really a significant healthcare issue?
While obstetric fistula is now uncommon in countries with reliable access to skilled maternal healthcare, it remains a serious issue in Ethiopia, where 80% of the population lives in remote areas. Many women don’t have timely access to skilled birth attendants or emergency obstetric care. As a result, around 1,000 new obstetric fistula cases occur in Ethiopia each year.
Hamlin is working to change this through treatment, prevention and training. The Hamlin College of Midwives trains women to an international standard and deploys them to rural communities, where they provide life-saving maternal healthcare.
Is obstetric fistula caused by a woman doing something wrong during pregnancy?
Obstetric fistula is never a woman’s fault. It occurs when a woman endures prolonged, obstructed labour without access to medical care. If the baby cannot move safely through the birth canal and there is no emergency intervention (such as a caesarean section), sustained pressure cuts off blood supply to the surrounding tissue. This causes a hole to form between the birth canal and the bladder or rectum. For women in remote areas, labour can continue for days before help is reached.
Obstetric fistula is a medical emergency caused by a lack of timely care, not by anything a woman has done wrong.
Obstetric fistula is never a woman’s fault. It occurs when a woman endures prolonged, obstructed labour without access to medical care.
- Dr Betelhem Tadese
Is obstetric fistula linked to the age of the mother?
Not primarily. In Ethiopia, the main cause of obstetric fistula is lack of access to maternal healthcare, especially during labour. Many women live far from health facilities, and some give birth at home without a skilled attendant present. If complications arise, families may have to walk long distances to seek help or carry a woman by stretcher to the nearest clinic.
By the time care is reached, it is often too late. In around 90% of obstetric fistula cases, the baby is stillborn.
Is obstetric fistula a curse, witchcraft or punishment from God?
This is a deeply harmful myth. Beliefs like these can cause women to be rejected by their families and communities, adding shame and isolation to an already devastating injury. At Hamlin Fistula Ethiopia, our treatment is about more than just surgery. It is also about restoring dignity and helping women understand that they have done nothing wrong.
Does obstetric fistula happen because a woman is unclean or has poor hygiene?
Absolutely not. Hygiene has nothing to do with the cause of obstetric fistula. The constant leakage of urine or faeces happens because the injury has created a hole between the birth canal and the bladder or rectum.
A woman cannot control this, no matter how much she washes. The injury can cause skin infections and odour, but these are consequences of fistula, not the cause. What a woman needs is medical treatment, not blame.
Is obstetric fistula caused by a sexually transmitted infection?
Many communities live in extremely poor conditions and their lives are often very fragile. Obstetric fistula is not caused by an STI. The injury is mechanical, caused by prolonged pressure during labour, not by infection. Confusing fistula with sexually transmitted infections only increases stigma and isolation for affected women.
Can female genital mutilation cause obstetric fistula?
This is a common assumption, but while FGM is a serious human rights violation with severe health consequences of its own. And obstetric fistula injury occurs higher in the birth canal than the area affected by FGM.
