Women who give birth without skilled attendance are at risk of conditions that can have serious effects on their health and wellbeing. Obstetric fistula is a devastating childbirth injury which leads to both physical and social harm for women.

Obstetric fistula is a hole between the vagina and bladder or rectum, usually caused by prolonged labour without intervention. Fistula leaves women leaking urine or faeces, or both, and typically results in social isolation and depression. Obstetric fistula occurs in the context of early marriage, where girls are not physically ready to bear a child, and durinig prolonged labour due to inadequate health care.

In Afghanistan, four in every 1,000 women are believed to suffer from the condition - a quarter of these were younger than 16 when they married.

UNFPA seeks to address obstetric fistula through a three-pronged approach: preventing early marriage and supporting skilled attendance and basic and comprehensive emergency obstetric care at birth; good medical care to treat minor fistula and referrals to trained surgeons for severe cases; and supporting reintegration into communities after treatment.

In 2007, Malalai Maternity Hospital in Kabul became the only health facility in the country to train surgeons and to treat obstetric fistula in its UNFPA-supported Fistula Ward. Today, the hospital reports a 95 percent success rate and has treated an estimated 930 fistula cases in the last five years. UNFPA has also supported the Afghanistan Society of Obstetricians and Gynaecologists in providing training on the prevention of fistula.