About two million women and girls in developing countries suffer from obstetric fistula. During a difficult childbirth a fistula or hole can develop between the rectum and vagina or bladder and vagina. It can cause paralysis, infertility, incontinence, as well as stigma due to odor or a perception that a woman is not clean.

In 2003, the UN Population Fund launched the Global Campaign to End Fistula; and it has just released its annual report.  Kate Ramsey oversees UN agency?s fistula campaign.  From New York, she spoke to VOA English to Africa Service reporter Joe De Capua about the scope of the problem.

?Obstetric fistula was little known for a long time, but it?s really emerging that it continues to exist across the continents of Asia and Africa predominantly?but due to better access to maternal health care services to obstetric services in most parts of the world it?s been eliminated. But because in Asia and Africa we know many women do not have access to that care. They are dying in childbirth and those that actually survive some of them end up with obstetric fistula,? she says.

What is life like for women with the medical problem? Ramsey says, ?For many of the women they live as outcasts within their own society. And even if their families do not reject them, the women themselves may feel such shame that they isolate themselves. So they cease to interact with society?often?their connections with their husbands or family are severed. (They) don?t have a way to support themselves economically. They may received some assistance to live, but it?s difficult for them to work as well, because as you can imagine they?re constantly leaking urine.? The condition also makes them more vulnerable to other health problems and poverty.

There is treatment for obstetric fistula. Ramsey says, ?It?s a surgery that literally closes the hole?somewhere from 60 to 70 percent of the cases we know that this is a fairly simple procedure. But there are a number of cases that are quite complicated that are going to require a higher level of care. And some women have very extensive damage from the delivery that goes beyond even the fistula and for those women it is quite difficult to make a difference.?

The Campaign to End Fistula has grown from 12 countries in 2003 to nearly 40.