Global GynecologyContemporary Issues in Obstetric FistulaWALL, L. Lewis MD, DPhil*,†; OUEDRAOGO, ITENGRE MD‡; AYENACHEW, FEKADE MD§ Author Information *Department of Anthropology, College of Arts and Sciences †Department of Obstetrics and Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri ‡Association Renaissance Arena, Ouagadougou, Burkina Faso Danja Fistula Center, Danja, Niger §International Fistula Alliance, Terrewode Women’s Community Hospital, Soroti, Uganda The authors declare that they have nothing to disclose. Correspondence: L. Lewis Wall, MD, DPhil, Department of Anthropology, Washington University in St. Louis, MO. E-mail: [email protected] Clinical Obstetrics and Gynecology: September 2021 - Volume 64 - Issue 3 - p 491-500 doi: 10.1097/GRF.0000000000000630 Buy Metrics Abstract We discuss a variety of contemporary issues relating to obstetric fistula. These include definitions of these injuries, the etiologic mechanisms by which fistulas occur, the role of specialist fistula centers in diagnosis and management, the classification of fistulas, and the assessment of surgical outcomes. We also review the growing need for complex reconstructive surgical procedures, follow-up challenges, and the transition to a fistula-free world in which other pathologies (such as pelvic organ prolapse) will be of increasing importance. Finally, we discuss the need to develop responsive systems of maternal health care that treat women with competence, compassion, respect, and fairness. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.