FIGO Fistula Initiative


Genital fistula is a distressing condition that can arise from a number of causes.  The most common and most devastating type of genital fistula found in developing countries is obstetric fistula, a hole in the birth canal usually caused by prolonged obstructed labour.  Obstetric fistula results, in nearly all cases, in the death of the baby and leaves the woman suffering from a range of health problems which include chronic incontinence.  The chronic incontinence often has severe psychosocial and socioeconomic consequences that are brought on by social segregation—which in many cases results in loss of livelihood, isolation, feelings of shame and despair. 

According to the World Health Organization each year between 50,000 to 100,000 women develop obstetric fistula.  These figures are likely to be greatly underestimated as many sufferers—often adolescents and young women—are unaware that treatment for the condition exists or are unable to obtain treatment due to a variety of reasons, including financial constraints and a significant lack of surgeons trained to care for women with obstetric fistula. 

Obstetric fistula is a completely preventable condition of labour which can largely be avoided by ensuring that women have timely access to obstetric care, by ending harmful traditional practices such as Female Genital Mutilation (FGM) and delaying the age of first pregnancy. 



Project Purpose:

To ensure high quality clinical training for the care of women with obstetric fistula and to increase the capacity of service sites and staff to provide comprehensive management and treatment of obstetric fistula through a programme of training of trainers (ToT) and support to training centres. 

Project Objective:

To implement a structured obstetric fistula surgical training programme in sub-Saharan Africa using a standardised training curriculum. 

Current capacity to deliver necessary care for women living with obstetric fistula is woefully inadequate.  There are too few physicians equipped with the knowledge and skills required to repair obstetric fistula or to provide rehabilitative care following the surgery.  Most procedures are performed by committed local physicians in Africa and Asia with technical support from surgeons in high-resource countries where obstetric fistula is rarely seen. 

Although the need for physicians to be trained in obstetric fistula repair has long been recognised, no standard method for the training of these physicians has existed.  To meet this need, FIGO has facilitated the development of a competency-based training manual and accompanying training programme for surgeons to gain the knowledge, skills and professionalism that they will need to help prevent new cases of obstetric fistula and to provide the necessary holistic care for women who have incurred obstetric fistula whether through child birth or due to inflicted trauma. Learn more about our partners and their obstetric fistula programmes:

The Fistula Care Project

The Campaign to End Fistula

The Fistula Foundation

Johnson & Johnson


Global Competency-Based Fistula Surgery Training Manual (2011)

The purpose of the Manual was produced with funding from the United Nations Population Fund (UNFPA) and with the collaboration of fistula surgeons, professional organisations and specialist health organisations - including the International Society of Obstetric Fistula Surgeons (ISOFS); EngenderHealth; and the Royal College of Obstetricians and Gynaecologists (RCOG).  FIGO’s Fistula Committee played a pivotal role in the development of the Manual. 

The manual, which is available in English and French, was pilot tested and is currently being used to train the first group of Fistula Surgery Training Fellows. 

Global Competency-Based Fistula Surgery Training Manual (2011, English)

Global Competency-Based Fistula Surgery Training Manual (2011, French)


Obstetric Fistula Surgery Training Centre Accreditation

The Global Competency-Based Fistula Surgery Training Manual is available in its entirety at no cost through this website in order to promote the use of a standardised training for obstetric fistula surgery.   

Although any interested centre is encouraged to use the manual for training, not every centre using the manual has received FIGO accreditation.  There are certain qualifications which centres much meet in order to receive this accreditation. Learn more about the criteria for training centre accreditation. 

 If you are a surgeon who has used the manual in whole or in part for training, please contact us. This is not required, but we would like to hear your experiences of using the manual as we continue to evaluate the manual’s efficacy in the development in obstetric fistula surgery competency. 

Please check back with us soon for a list of accredited training centres.  The list will be updated on a regular basis and will provide useful information on each training site.




The film ‘Fistula Pilgrims’ was written, produced and directed by Nancy Durrell McKenna for FIGO in collaboration with Safehands for Mothers, an organisation she founded.  It tells the story of Telanish, a young girl in Ethiopia who was married at 10, pregnant at 11, and gave birth to a stillborn child at 12.  As a result of a long and obstructed labour, she has developed a fistula and was left incontinent—and an outcast from her community.  

With training, the complications that cause obstetric fistula can be avoided, thus sparing young women like Telanish a lifetime of misery. Watch Telanish’s story here


An article, Pursuing a standard of care for training new fistula surgeons, written by Professor Hamid Rushwan (FIGO Chief Executive) and Joseph Ruminjo (Clinical Director of EngenderHealth’s Fistula Care Project), was posted on the website RH Reality Check in March 2011.  The article is part of a series of online articles on Obstetric Fistula. 

Read the article here.




World Congress 2015