“The persistence of fistula is a result of human rights denied and a reflection of human rights abuse,” Babatunde Osotimehin, Executive Director of the UN Population Fund (UNFPA), said in his message marking the first-ever International Day to End Obstetric Fistula.

“It reflects chronic health inequities and health-care system constraints, as well as wider challenges, such as gender and socio-economic inequality, child marriage and early child bearing, all of which can undermine the lives of women and girls and interfere with their enjoyment of their basic human rights.”

An estimated three million women and girls, nearly all in developing countries, are affected with another 50,000 to 100,000 new cases developing each year, according to figures cited by UNFPA and the UN World Health Organization (WHO).

An obstetric fistula is a hole in the birth canal caused by the baby’s head pushing against the mother’s pelvic bone during contractions, often without adequate medical care during prolonged labour. The hole forms between a woman’s vagina and her bladder or rectum, causing her to leak bodily fluids.

The newborn rarely survives, if it is born live, and renders the woman incapable of having more children. Shunned by their families and communities, women with fistula are often poor and marginalized.

According to UNFPA, women and girls with obstetric fistula are usually poor, often illiterate, with limited access to health services, including maternal and reproductive health care.

“In an age of rapid globalization in which mobile and e-technologies have changed the face of human communications and revolutionized the frontiers of science and medicine, it is unconscionable that the poorest, most vulnerable women and girls continue to suffer needlessly from this scourge,” Mr. Osotimehin said.

Reconstructive surgery to fix the condition cost around $400 according to the global Campaign to End Fistula, which UNFPA leads and coordinates with a wide range of partners. The campaign is based on three key strategies of prevention, treatment and social integration.

Over the past decade, the agency provided support to more than 50 countries, resulting in fistula treatment and care for some 34,000 women and the training of thousands of health-care personnel in prevention and management.

“We are training more health workers close to where people live so that they don’t have to travel long distances before they get the service,” Mr. Osotimehin told UN Radio. “We don’t have to have a midwife that is super-qualified. You can actually train a cadre of staff over a short period of time to be able to deliver good quality service under supervision.”

Where prevention is not possible, treatment is more often an option. In Mozambique, 16-year-old Essita Mulhanga underwent surgery to repair her fistula.

In a 2012 report, Secretary-General Ban Ki-moon urged dramatically intensified political and financial mobilization to accelerate progress towards ending obstetric fistula.

He called for at least $750 million to treat all cases of obstetric fistula by 2015, the deadline for the eight anti-poverty targets known as the Millennium Development Goals (MDGs) towards which the UN is boosting efforts in its “1,000 days of action” campaign.

“This is part of our broader effort to reach the Millennium Development Goals and mobilize partners in the Every Woman, Every Child initiative,” Mr. Ban said today in his message on the Day.

“The benefits reverberate far beyond the women who are directly affected, extending to children who will be raised by healthy mothers and communities that benefit from their contributions.”

In his report, Mr. Ban noted three interventions that have the most important and immediate impact on maternal death and disability: family planning; attendance during childbirth by skilled health personnel, such as a midwife; and emergency obstetric care, in particular Caesarean sections.

Early marriage is also an issue with adolescent girls particularly at risk for obstetric fistula at a much higher rate than women in their twenties.

Highlighting the importance of the International Day to End Obstetric Fistula to raise awareness of the condition, Mr. Ban said: “The more understanding and action we generate today, the more we can look forward to a future where obstetric fistula is virtually unknown because it is virtually non-existent.”

“In the Democratic Republic of Congo, far too many mothers die of maternity-related causes even though they are able to access healthcare relatively easily,” said Eustache Ouayoro, World Bank Country Director for the Democratic Republic of Congo. “The main problem is the quality of primary healthcare that women get at clinics, and this new World Bank grant will directly help improve services for them.”

The grant will be used to reduce untimely deaths among women and promote safer childbirth by boosting capacity to deliver good obstetric care at health facilities. It will also help train staff to serve women who have suffered gender-based violence, and will make modern contraceptives more easily available.

The health status of women in the DRC reflects stark gender inequalities, with nearly one in five women being underweight, and women in cities being at considerably higher risk of getting HIV. To try to close this gender gap in health, the grant will help expand nutrition activities at clinics for both women and children, and help continue the supply of anti-retroviral treatment to those living with HIV/AIDS.

Finally, the grant will support a pilot project in Katanga that uses performance-based financing to improve services at health facilities, expanding it by more than 1 million beneficiaries. Although preliminary results are encouraging, it is important to complete the ongoing evaluation of this approach so that the DRC can take an informed decision on whether to adopt it more widely.

The World Bank’s International Development Association (IDA), established in 1960, helps the world’s poorest countries by providing loans (called “credits”) and grants for projects and programs that boost economic growth, reduce poverty, and improve poor people’s lives. IDA is one of the largest sources of assistance for the world’s 81 poorest countries, 39 of which are in Africa. Resources from IDA bring positive change for 2.5 billion people living on less than $2 a day. Since 1960, IDA has supported development work in 108 countries. Annual commitments have increased steadily and averaged about $15 billion over the last three years, with about 50 percent of commitments going to Africa.

The report, entitled Trends in Maternal Mortality: 1990 to 2010, shows that from 1990 to 2010, the annual number of maternal deaths dropped from more than 543,000 to 287,000 – a decline of 47 per cent.

While substantial progress has been achieved in almost all regions, many countries – especially in sub-Saharan Africa – will fail to reach the Millennium Development Goal (MDG) target of reducing maternal deaths by 75 per cent from 1990 to 2015.

“I am very pleased to see that the number of women dying in pregnancy and childbirth continues to decline,” said Babatunde Osotimehin, the Executive Director of the UN Population Fund (UNFPA), which released the report along with the World Health Organization (WHO), the UN Children’s Fund (UNICEF) and the World Bank. “This shows that the enhanced effort of countries, supported by UNFPA and other development partners, is paying off,” he added. “But we can’t stop here. Our work must continue to make every pregnancy wanted and every childbirth safe.”

According to a news release issued by the agencies, a woman dies of pregnancy-related complications every two minutes. The four most common causes are severe bleeding after childbirth, infections, high blood pressure during pregnancy, and unsafe abortions.

Ninety-nine per cent of maternal deaths occur in developing countries; most could have been prevented with proven interventions.

“We know exactly what to do to prevent maternal deaths: improve access to voluntary family planning, invest in health workers with midwifery skills, and ensure access to emergency obstetric care when complications arise,” said Dr. Osotimehin.

The report shows that one-third of all maternal deaths occur in just two countries. In 2010, almost 20 per cent of deaths, or 56,000, were in India, and 14 per cent, or 40,000, were in Nigeria. Of the 40 countries with the world’s highest rates of maternal death, 36 are in sub-Saharan Africa.

Similarly, East Asia, which made the greatest progress in preventing maternal deaths, has a contraceptive prevalence rate of 84 per cent as opposed to only 22 per cent in sub-Saharan Africa, a region that has the highest rates of maternal death.

Ten countries have already reached the MDG target of a 75 per cent reduction in maternal death: Belarus, Bhutan, Equatorial Guinea, Estonia, Iran, Lithuania, Maldives, Nepal, Romania and Viet Nam.

There are a total of eight MDGs, ranging from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015. They form a blueprint agreed to by all the world’s countries and all the world’s leading development institutions and have galvanized unprecedented efforts to meet the needs of the world’s poorest.