Uganda is facing a silent public health crisis: over 98% of women suffering from obstetric fistula remain untreated, trapped in a cycle of pain, stigma, and social isolation.
According to the Ministry of Health, an estimated 19,000 new cases of obstetric fistula occur each year. Yet only about 1,700 women—roughly 2.2%—receive corrective surgery annually. The total number of women currently living with the condition is estimated at more than 74,000.
“These figures are not just numbers; they represent women who have endured years of suffering, often in silence,” said Dr. Ronny Bahatungire, Acting Commissioner for Clinical Services.
Obstetric fistula is a devastating childbirth-related injury caused by prolonged, obstructed labor. It creates a hole between the birth canal and the bladder, rectum, or both, resulting in continuous leakage of urine or stool. This leads to social exclusion, depression, and a profound loss of dignity.
While surgery can repair the injury, most women wait an average of seven years to receive treatment. The long delay is often due to a lack of trained specialists, limited access in rural areas, and prohibitive costs.
“Even with ongoing interventions, mothers still wait years for treatment,” Dr. Bahatungire said. “By then, the damage is not just physical—it’s psychological and social.”
A full recovery requires more than surgery. Many women return to homes that once rejected them and communities where the stigma still lingers. They attempt to rebuild lives that have been on hold for years.
Uganda currently has only five fistula surgeons, most of them based in Kampala. Rural areas remain severely underserved. Outside of donor-funded programs, private surgeries can cost between $350 and $1,000—an amount far beyond the means of most affected women.
“Without support, treatment is simply unaffordable,” said Dr. Godfrey Alia, a specialist in fistula repair.
The regions of Buganda, Ankole, Lango, and Busoga report the highest number of cases. Contributing factors include early marriage and a cultural resistance to Caesarean sections. In many communities, vaginal delivery is preferred even in high-risk pregnancies.
“Some of these injuries are entirely preventable if proper delivery care is prioritised,” said Dr. Geofrey Mugisha, Principal Medical Officer for Clinical Services.
Uganda also struggles with high rates of teenage pregnancy and low antenatal care attendance—both risk factors for obstructed labor. Young mothers are particularly vulnerable due to underdeveloped pelvises and limited awareness of safe delivery options.
To address the crisis, the United Nations Population Fund (UNFPA) has launched a comprehensive fistula care programme in Busoga. It includes:
- Surgical repairs
- Psychosocial support
- Training of healthcare workers
“No woman or girl should have to endure the agony of obstetric fistula,” said UNFPA Executive Director Dr. Natalia Kanem. “We must ensure that every woman and girl—no matter who she is or where she lives—can access the high-quality sexual and reproductive health services that are her right.”
Meanwhile, the Ugandan government has introduced a three-year fellowship in Urogynecology at Mbarara University of Science and Technology to train more specialists.
Dr. Bahatungire and the Ministry of Health are calling for:
- Nationwide awareness campaigns to reduce stigma and encourage early detection
- Increased funding for surgical camps and specialist training
- Integration of fistula treatment into broader maternal health services
Since 2003, UNFPA has supported nearly 150,000 fistula surgeries globally and helped reintegrate over 15,000 women and girls through counselling, vocational training, and community dialogue. But these efforts, they warn, meet only a fraction of the global need.
In Uganda, many fistula survivors continue to struggle to find employment, rebuild relationships, or regain confidence to rejoin village life. Without sustained psychosocial support and economic empowerment, even successfully treated women risk falling back into isolation.
“We must not allow a woman’s life to be ruined by a childbirth injury that is entirely treatable,” Dr. Bahatungire emphasized.
Obstetric fistula is both preventable and treatable. Yet thousands of Ugandan women continue to suffer in silence—held back by poverty, stigma, and a fragile healthcare system. Without urgent investment in infrastructure, education, and specialist training, the vision of eradicating fistula will remain out of reach for far too many.