By Alfa Bothwell Gwatidzo
In my community, when a baby is born, we say “makorokoto, mapona”—“congratulations, you survived.” These words, while celebratory, echo a painful reality for many women in Zimbabwe. Childbirth remains perilous, especially in underserved communities where access to timely medical care is often a luxury. Among the most devastating consequences is obstetric fistula—a preventable and treatable condition that continues to trap women in cycles of pain, isolation, and stigma.
Obstetric fistula occurs when prolonged, obstructed labour creates a hole between the birth canal and the bladder or rectum. The result is chronic incontinence, often accompanied by a strong odour that drives women into isolation and economic marginalization. Most suffer silently, unaware that the condition is curable—or too ashamed to seek help due to prevailing myths.
Zimbabwe’s maternal mortality rate stands at 362 deaths per 100,000 live births (WHO, 2020), one of the highest in the region. Obstetric fistula plays a hidden role in this statistic. Women in rural areas may walk over 30 kilometres to the nearest clinic, often while in advanced labour. Even with commendable community health systems in place, delays in referral, a lack of skilled birth attendants, and the absence of emergency obstetric care facilities mean many women suffer preventable injuries during childbirth.
Once affected, women are burdened not only by the physical pain and indignity of constant leakage, but also by abandonment from spouses, exclusion from community life, and the inability to earn a living. The trauma is compounded by the psychological toll of stigma, shame, and internalized guilt. In some traditional contexts, fistula is wrongly attributed to witchcraft or divine punishment, reinforcing harmful narratives that dehumanize survivors.
So what causes obstetric fistula in Zimbabwe? It is not merely a health issue—it is a painful symptom of deeply entrenched social, economic, and cultural inequalities. It is, fundamentally, a human rights issue. The root causes are numerous and interconnected, each playing a role in a woman’s risk of developing this condition.
For many families, accessing health care is simply too expensive. Even where public maternal services exist, hidden costs—such as transport, medical supplies, or accommodation near clinics—often push care out of reach. In remote areas, expectant mothers may live far from the nearest health facility. Without reliable ambulances or maternity waiting homes, they are left with no choice but to deliver at home or with unskilled birth attendants, increasing the risk of prolonged and obstructed labour.
Even when women do reach a health facility, the available care may be limited or nonexistent. Some clinics lack the capacity to handle labour complications—they may not have surgical facilities, blood transfusion services, or trained staff to perform caesarean sections. Delays or inadequacies in receiving emergency obstetric care directly cause many fistula cases. A woman may arrive in time, but if the system fails to respond effectively, she still suffers.
Poverty remains one of the most persistent drivers of fistula. Poor families often cannot afford antenatal visits or nutritious food needed for a safe pregnancy. Poverty also drives young girls out of school and into early marriages, increasing their risk of childbirth complications. Once a woman develops fistula, her ability to work and earn a living is drastically reduced, perpetuating the cycle of poverty and marginalization.
Certain religious beliefs, particularly among conservative Apostolic sects, contribute significantly to poor maternal health outcomes. These groups often reject modern medicine, encouraging home births or reliance on spiritual healers instead of trained professionals. Patriarchal teachings further discourage women from seeking help, even during emergencies. The result is preventable injury—and all too often, preventable death.
Girls who marry before 18 are often not physically mature enough to give birth safely. Zimbabwe continues to grapple with high rates of child marriage, especially in rural areas. These young mothers are more likely to experience obstructed labour due to underdeveloped pelvises, which leads directly to fistula. Teenage pregnancies are also associated with reduced access to prenatal care and limited decision-making power, increasing the risk.
Take, for instance, the story of young girls—married off at 15, pregnant by 16, giving birth at home or at shrines after two days of labour. Chances are the baby will not survive, and the mother will be left with fistula. Often, her husband will leave shortly after. For months, she may be confined to a single room, avoided by neighbours and relatives. Only when a community health volunteer or someone with accurate information meets her will she learn that the condition has a name—and a cure.
Unfortunately, these are not imagined scenarios. In Zimbabwe, hundreds of women live with untreated fistula. Only a small fraction access the life-transforming surgery provided through campaigns led by the Ministry of Health and Child Care (MoHCC), UNFPA, and other partners. While these interventions are impactful, they often focus solely on clinical repair—overlooking the equally critical need for psychosocial reintegration and community education. That is why Amnesty International Zimbabwe is running a campaign to sensitize communities.
As a sexual and reproductive health and rights champion, I assert that obstetric fistula is a human rights issue. I strongly recommend that the government scale up both surgical and psychosocial support. The current capacity for obstetric fistula repair remains limited and highly centralized. There is an urgent need to decentralize services and ensure at least one fistula repair unit per province. This should be complemented by mobile surgical outreach programs to reach remote districts.
The response must also go beyond physical repair. Survivors face immense emotional trauma, stigma, and isolation. Trauma-informed mental health care, survivor support groups, and peer mentorship must be integrated into the post-surgery recovery process. The government and partners must also invest in training and retaining surgeons with fistula-specific expertise.
Community education is also essential. Misconceptions, shame, and silence hinder early intervention and support. Strategic public education campaigns are needed—combining radio, SMS blasts, drama series, and survivor-led storytelling. These campaigns should be culturally sensitive, delivered in local languages, and should tackle myths like fistula being a curse. Instead, they must present it as a preventable and treatable medical condition. Those affected should be referred to the Ministry of Health’s toll-free number: 08080231. Faith leaders, traditional authorities, and school educators must be equipped with accurate information to spread within their circles.
Male engagement is another vital factor. Maternal health should not be viewed as solely a women’s issue. Men—fathers, partners, community leaders—must be engaged in both prevention and care. Zimbabwe can learn from models like Sierra Leone’s “Men as Partners” program, which trains men in birth preparedness, respectful relationships, and postnatal support. Such initiatives should be embedded into maternal health policy, with incentives for community health workers to recruit and support male champions.
Investment in health infrastructure, especially in underserved areas, is critical. A large percentage of fistula cases result from delays in accessing emergency obstetric care. Health centres need essential equipment, reliable electricity, and trained personnel. Ambulance services should be expanded and strategically placed in hard-to-reach areas. Referral pathways should be digitized where possible to allow real-time tracking of obstetric emergencies. Maternity waiting homes—safe spaces near health centres for women nearing delivery—must also be prioritized.
Lastly, we must support young girls and women who have endured fistula or early motherhood. Many face permanent school dropout, poverty, and social rejection. The government, with civil society organizations, should implement school reintegration policies offering tuition waivers, counselling, and peer support. For those unable to return to school, vocational training aligned to market demands must be provided—along with seed funding and mentorship for business startups. These interventions are not just economic; they restore dignity, agency, and hope.
As we commemorate World Obstetric Fistula Day today, let us be reminded: this is not just a medical condition—it is a gender justice issue. It reflects how much society values women’s health, dignity, and autonomy. If we are to build an inclusive Zimbabwe, we must confront the structural inequalities that cause and perpetuate this suffering. So that one day, we no longer say “makorokoto, mapona” out of relief, but “makorokoto, wakachengetedzwa”—congratulations, you were cared for. With collective action, political will, and men standing in solidarity, we can consign obstetric fistula to the past and restore dignity to every woman.
About the Author: Alfa Bothwell Gwatidzo is a Social worker ,Researcher, Amnesty Zimbabwe SRHR Champion and advocate
