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Updated: Aug 6, 2026
Removal of an Intravesical Gellhorn Pessary and Staged Repair of a Residual Large Vesico-Vaginal Fistula
Published on: April 14, 2026
Prevalence of obstetric fistula: a systematic review and meta-analysis of available evidence from 38 countries
Yurong Shu1, Meiling Xu2, Bolan Li3
1Department of Obstetrics and Gynecology, Shuangliu District Maternal and Child Health Hospital, Chengdu, Sichuan, 610200, China.
Background:
Obstetric fistula remains a preventable childbirth injury, but prevalence evidence is uneven across countries and regions. We synthesized country-level and regional evidence on obstetric fistula prevalence through 2025.
Methods:
We searched MEDLINE/PubMed, Scopus, Embase, and other sources through October 1, 2025. Eligible cohort, cross-sectional, and survey datasets reported obstetric fistula or survey-defined obstetric fistula symptoms as a distinct outcome with a defined denominator. Pooled prevalence estimates were calculated using random-effects meta-analysis with Freeman-Tukey double-arcsine transformation. Subgroup analyses and meta-regression explored heterogeneity across geographic, socioeconomic, temporal, demographic, and study-level factors.
Results:
Sixty-two datasets from 38 countries included 2,547,755 women and 15,976 obstetric fistula cases. The overall pooled prevalence was 0.76% (95% CI: 0.47-1.05; I² = 99.97%). Regional prevalence was highest in the African Region (0.96%), followed by South-East Asia (0.63%), Europe (0.32%), the Eastern Mediterranean Region (0.13%), and North America (0.11%; regional subgroup P = 0.026). Subgroup differences were significant across income categories (P = 0.002) and HDI strata (P < 0.001), with higher estimates in lower-middle-income countries (0.94%), low-income countries (0.80%), and low-HDI settings (1.00%). High-risk populations (1.35%) and hospital-based studies (0.95%) had higher estimates than general-population (0.69%) and community-based studies (0.65%). Temporal differences should be interpreted cautiously because they may reflect methodological and population differences rather than true changes in disease burden.
Conclusion:
Available evidence indicates that obstetric fistula remains unevenly distributed and highly heterogeneous. Standardized definitions, broader surveillance, and strengthened emergency obstetric and surgical services are needed to guide prevention, treatment, and progress monitoring toward fistula eradication.