"[19] The most direct consequence of an obstetric fistula is the constant leakage of urine, feces, and blood as a result of a hole that forms between the vagina and bladder or rectum.

For example, in Burkina Faso, most citizens do not believe an obstetric fistula to be a medical condition, but as a divine punishment or a curse for disloyal or disrespectful behavior.

[24] Now marginalized members of society, girls are forced to live on the edges of their villages and towns, often in isolation in a hut where they will likely die from starvation or an infection in the birth canal.

Accounts of women who develop obstetric fistulae proclaim that their lives have been reduced to the leaking of urine, feces, and blood because they are no longer capable or allowed to participate in traditional activities, including the duties of wife and mother.

Some women have formed small groups and resorted to walking to seek medical help, where their characteristic odor makes them a target for sub-Saharan predatory wildlife, further endangering their lives.

[29] Moreover, women are sometimes forced to turn to commercial sex work as a means of survival because the extreme poverty and social isolation that result from obstetric fistulae eliminate all other income opportunities.

[30] Some common psychological consequences that women with a fistula face are the despair from losing their child, the humiliation from their smell, and inability to perform their family roles.

For example, a 1983 study in Nigeria found that 54.8% of the women affected were under 20 years of age, and 64.4% gave birth at home or in poorly equipped local clinics.

[citation needed] Social, political, and economic causes that indirectly lead to the development of obstetric fistulae concern issues of poverty, malnutrition, lack of education, early marriage and childbirth, the role and status of women in developing countries, harmful traditional practices, sexual violence, and lack of good quality or accessible maternal and health care.

[41] Furthermore, impoverished countries not only have low incomes, but also lack adequate infrastructure, trained and educated professionals, resources, and a centralized government that exist in developed nations to effectively eradicate obstetric fistulae.

[15] This weak and underdeveloped bone structure increases the chances that the baby will get stuck in the pelvis during birth, cutting off circulation and leading to tissue necrosis.

This lack of information in combination with obstacles preventing rural women to easily travel to and from hospitals lead many to arrive at the birthing process without prenatal care.

These techniques often fail in the event of unplanned emergencies, leading women to go to the hospital for care too late, desperately ill, and therefore vulnerable to the risks of anesthesia and surgery that must be used on them.

[41] In addition, studies find that education is associated with lower desired family size, greater use of contraceptives, and increased use of professional medical services.

"[1] In addition, access to health services and education – including family planning, gender equality, higher living standards, child marriage, and human rights – must be addressed to reduce the marginalization of women and girls.

One of these strategies involves organizing community-level awareness campaigns to educate women about prevention methods such as proper hygiene and care during pregnancy and labor.

Some organizations train local nurses and midwives to perform emergency cesarean sections to avoid vaginal delivery for young mothers who have underdeveloped pelvises.

[49] These survivors help current patients, educate pregnant mothers, and dispel cultural myths that obstetric fistulae are caused by adultery or evil spirits.

[46][63] Adequate population-based epidemiological data on obstetric fistulae are lacking due to the historic neglect of this condition since it was mostly eradicated in developed nations.

[citation needed] Countries that signed the United Nations Millennium Declaration have begun adopting policies and creating task forces to address issues of maternal morbidity and infant mortality, including Tanzania, Democratic Republic of Congo, Sudan, Pakistan, Bangladesh, Burkina Faso, Chad, Mali, Uganda, Eritrea, Niger, and Kenya.

To monitor these countries and hold them accountable, the UN has developed six "process indicators", a benchmark tool with minimum acceptable levels that measures whether or not women receive the services they need.

[15] The UNFPA set out several strategies to address fistulae, including "postponing marriage and pregnancy for young girls, increasing access to education and family planning services for women and men, provide access to adequate medical care for all pregnant women and emergency obstetric care for all who develop complications, and repairing physical damage through medical intervention and emotional damage through counselling.

"[68] One of the UNFPA's initiatives to reduce the cost of transportation in accessing medical care provided ambulances and motorcycles for women in Benin, Chad, Guinea, Guinea-Bissau, Kenya, Rwanda, Senegal, Tanzania, Uganda, and Zambia.

Partners in this initiative include Columbia University's Averting Maternal Death and Disability Program, the International Federation of Gynecology and Obstetrics, and the World Health Organization.

Other tasks undertaken by the campaign include fundraising and introducing new donors and gathering new partners of all perspectives, such as faith-based organizations, NGOs, and private-sector companies.

[16] The goals of this initiative were to alleviate the backlog of patients waiting for surgery, provide treatment services at host sites, and to raise awareness for maternal health.

[31] Since poverty is an indirect cause of obstetric fistulae, some community organizations aim to provide postoperative services to enhance the women's socioeconomic situation.

An example of a well functioning treatment center is in Bangladesh where a facility has been created in association with the Dhaka Medical College Hospital with support from the United Nations Population Fund.

Another example is a fistula unit in N'djamena, Chad, which has a mobile clinic that travels to rural, hard-to-reach areas, to provide services, and works in association with Liberty Hospital.

[74] The World Health Organization has created a manual articulating necessary principles for surgical and pre- and post- operative care regarding obstetric fistula, providing a beneficial outline for affected nations.