Ghana cannot end fistula with awareness alone

After two decades of advocacy, obstetric fistula still exposes deep failures in equity, emergency care and political accountability in Ghana.

For two decades, Ghana has marked the occasion with campaigns, conferences and commemorative days dedicated to ending obstetric fistula.

Yet, for too many poor women and girls, especially in deprived and rural communities, fistula remains a brutal and preventable reality.

We can continue congratulating ourselves on incremental progress or we can confront the structural inequality that keeps this injury alive.

Ghana must choose the latter.

No woman should suffer a childbirth injury simply because she is poor, lives far from a well-equipped hospital, marries early, or cannot reach emergency care in time.

That is not misfortune. It is a public failure.

And if fistula continues to persist along lines of poverty and geography, then we must ask, plainly and urgently: who is accountable?

National emergency

Recent reporting drawing on the 2025 obstetric fistula burden study indicates that Ghana still carries a backlog of about 7,130 cases, while roughly 845 new cases emerge each year.

Although repairs have increased to more than 200 cases annually, the country would need about 2,249 repairs a year to meet the goal of elimination by 2030.

These figures do not describe a marginal problem. 

They describe a national emergency.

Too often, those of us in health and policy circles become skilled at naming the problem, presenting the data and repeating the familiar language of concern.

But describing suffering is not the same as ending it.

Technical knowledge matters only when it is translated into budget decisions, referral systems, transport, staffing, surgical capacity and leadership that acts with urgency.

Obstetric fistula is not simply a clinical condition. It is the visible scar of a health system that still fails its most vulnerable citizens.

It points to delayed access to emergency obstetric and newborn care, weak referral pathways, uneven infrastructure and the enduring consequences of poverty.

Equitable access to sexual and reproductive health services should not depend on where a woman lives or what she can afford.

National indicators

This is why the persistence of fistula in Ghana is so troubling. Even where national indicators suggest progress, the lived reality in many underserved districts tells a different story. 

Roads remain poor, transport is unreliable, district hospitals vary widely in readiness and referral delays still cost women their health, dignity and often their babies.

A country cannot claim success in maternal health while preventable childbirth injuries continue to devastate the poorest households.

A woman’s postal code and household income should never determine whether childbirth leaves her safe, healthy and hopeful—or incontinent, abandoned and invisible.

So, what would real political will look like?

It would mean measurable targets, funded repair services, stronger prevention, functioning referral systems, transport for women in labour and clear institutional responsibility for results.

It would mean treating fistula not as a charity issue or annual awareness event but as a test of whether Ghana is serious about maternal justice.

‘‘Her Health is a Right’.

If Ghana truly intends to end fistula, this is the moment for a national emergency response led from the highest level of government.

Whether that leadership comes from the Presidency, the Ministry of Health or a dedicated National Task Force under the Ghana Health Service, someone must own the process.

After two decades of campaigning, women living with fistula do not need more symbolism.

They need action now.

* The writer is a Fistula Surgeon at the Korle Bu Teaching Hospital