Intensification of Efforts to End Obstetric Fistula

A/RES/69/148No PDF available

Who created this mandate?

A Resolution of the General Assembly, under agenda item 27aAdvancement of women, published in 2015.

What other versions does this mandate have?

6 versions · 2015–2024

This is an older version — the most recent is A/RES/79/155

2024A/RES/79/155Intensification of efforts to end obstetric fistulaLatestCompare with previous version
2022A/RES/77/196Intensification of efforts to end obstetric fistulaCompare with previous version
2020A/RES/75/159Intensification of efforts to end obstetric fistulaCompare with previous version
2019A/RES/73/147Intensification of efforts to end obstetric fistulaCompare with previous version
2017A/RES/71/169Intensification of efforts to end obstetric fistulaCompare with previous version

Versions are identified automatically by matching titles within the same organ (~97% accuracy on a manual audit).

What subjects does this mandate have?

18 topics

Capacity Building Childbirth Data Collection Early Marriage Family Planning Girls Health Education International Days Maternal and Child Health Maternal Health Services Maternal Mortality Obstetric Fistula Reproductive Health Resources Mobilization Rural Areas Women's Education Women's Health Women's Rights

Which reports were submitted under this mandate?

1 report of the Secretary-General submitted under this mandate, 2016.

2016A/71/306Supporting efforts to end obstetric fistula report of the Secretary-General

Identified automatically from the metadata in each report’s UN Digital Library catalogue record.

What does this mandate say?

32 operative paragraphs

Recognizes the interlinkages between poverty, lack of or inadequate access to health-care services, early childbearing and child, early and forced marriage as root causes of obstetric fistula, that poverty and inequality remain the main social risk factor and that the eradication of poverty is critical to meeting the needs and rights of women and girls, and calls upon States, in collaboration with the international community, to take accelerated action to address the situation;

Stresses the need to address the social issues that contribute to the problem of obstetric fistula, such as poverty, lack of or inadequate education for women and girls, lack of access to health-care services, including sexual and reproductive health-care services, early childbearing, child, early and forced marriage and the low status of women and girls;

Calls upon States to take all measures necessary to ensure the right of women and girls to the enjoyment of the highest attainable standard of health, including sexual and reproductive health, and reproductive rights, in accordance with the Programme of Action of the International Conference on Population and Development,Error: Reference source not found the Beijing Platform for Action and the outcome documents of their review conferences, and to develop sustainable health systems and social services with a view to ensuring access to such systems and services without discrimination, while paying special attention to adequate food and nutrition, water and sanitation, family planning information, increasing women’s empowerment, knowledge and awareness and ensuring equitable access to high-quality appropriate prenatal and delivery care for the prevention of obstetric fistula and the reduction of health inequities, as well as postnatal care for the detection and early management of fistula cases;

Also calls upon States to ensure the right to education of good quality for women and girls, on an equal basis with men and boys, and to ensure that they complete a full course of primary education, and to renew their efforts to improve and expand girls’ and women’s education at all levels, including at the secondary and higher levels, and including age-appropriate sex education, as well as vocational education and technical training, in order to, inter alia, achieve gender equality, the empowerment of women and girls and poverty eradication;

Urges States to enact and strictly enforce laws to ensure that marriage, including in rural and remote areas, is entered into only with the free and full consent of the intending spouses and, in addition, to enact and strictly enforce laws concerning the minimum legal age of consent and the minimum age for marriage, and to raise the minimum age for marriage where necessary;

Calls upon the international community to provide intensified technical and financial support, in particular to high-burden countries, to accelerate progress towards the achievement of Millennium Development Goal 5 by 2015 and the elimination of obstetric fistula in the remaining days of the Millennium Development Goals and beyond 2015;

Urges multilateral donors, international financial institutions and regional development banks in the public and private sectors, within their respective mandates, to review and implement policies to support national efforts and institutional capacity-building to end obstetric fistula and to ensure that a higher proportion of resources reach young women and girls, in particular in rural and remote areas, as well as to ensure that needed funding is increased, predictable and sustained;

Calls upon the international community to support the activities of the United Nations Population Fund and other partners, including the World Health Organization, in the global Campaign to End Fistula in establishing and financing regional fistula treatment and training centres and, where necessary, national centres, by identifying and supporting health facilities that have the potential to serve as centres for treatment, training and convalescent care;

Calls upon States to accelerate progress in order to improve maternal health in the remaining days of the Millennium Development Goals and beyond 2015, by addressing sexual and reproductive, maternal, newborn and child health in a comprehensive manner, inter alia, through the provision of family planning, prenatal care, skilled attendance at birth, emergency obstetric and newborn care, postnatal care and methods of prevention and treatment of sexually transmitted diseases and infections, such as HIV, within strengthened health-care systems that provide equal access to affordable, equitable and high-quality integrated health-care services and include community-based preventive and clinical care, as also reflected in the outcome document of the high-level plenary meeting of the General Assembly on the Millennium Development Goals, entitled “Keeping the promise: united to achieve the Millennium Development Goals”,Error: Reference source not found and in the Secretary-General’s Global Strategy for Women’s and Children’s Health;

Urges the international community to address the shortage of doctors and the inequitable distribution of midwives, nurses and other health-care workers trained in lifesaving obstetric care, and of space and supplies, which limit the capacity of most fistula centres;

Commends the commemoration by the international community of 23 May as the International Day to End Obstetric Fistula and the decision to continue to use the International Day each year to significantly raise awareness and intensify actions towards ending obstetric fistula;

Calls upon States and/or the relevant funds and programmes, organs and the specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector:

To redouble their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high-quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care;

To make greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health-care services and ensure that women and girls have access to the full continuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery;

To support the training of doctors, nurses and other health-care workers in lifesaving obstetric care, especially midwives, who are the front-line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, and include training on fistula repair, treatment and care as a standard element of the training curricula of health professionals;

To ensure equitable access through national policies, plans and programmes that make maternal and newborn health-care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible, including in rural and remote areas and among the poorest women and girls, through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula;

To develop, implement and support national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula, to develop further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, including by ensuring access to affordable, accessible, comprehensive, high-quality maternal health-care services and, within countries, to incorporate into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor, vulnerable women and girls;

To establish or strengthen, as appropriate, a national task force for obstetric fistula, led by the Ministry of Health, to enhance national coordination and improve partner collaboration to end obstetric fistula;

To strengthen the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obstetric fistula and to treat existing cases by increasing national budgets for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of trained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled “Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development”, which provides background information and principles for developing fistula prevention and treatment programmes, as appropriate;

To mobilize funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well-being and survival and to prevent the recurrence of subsequent fistulas by making post-surgery follow-up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies;

To ensure that all women and girls who have undergone fistula treatment, including the forgotten women and girls with incurable or inoperable fistula, are provided with and have access to comprehensive health-care services, holistic social integration services and careful follow-up, including counselling, education, family planning and socioeconomic empowerment, for as long as needed, through, inter alia, skills development and income-generating activities, so that they can overcome abandonment and social exclusion, and to develop linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal;

To empower fistula survivors to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival;

To educate individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevented and treated, and increase awareness of the needs of pregnant women and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of health, including sexual and reproductive health, by working with community and religious leaders, traditional birth attendants, women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers;

To enhance the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and to further strengthen their involvement as partners, including in the Campaign to End Fistula;

To strengthen awareness-raising and advocacy, including through the media, to effectively reach families and communities with key messages on fistula prevention and treatment and social reintegration;

To strengthen research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes;

To strengthen research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near-miss cases as part of a national maternal death surveillance and response system, integrated within national health information systems;

To improve data collection, pre- and post-surgery, to measure progress in addressing the needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health-related complications, so as to address the challenges of improving maternal health;

To provide essential health-care services, equipment and supplies, skills training and income-generating projects to women and girls so that they can break out of the cycle of poverty;

Acknowledges that intensification of efforts is urgently needed to end obstetric fistula and, in this context, the importance of giving the issue due consideration in the elaboration of the post-2015 development agenda;

Invites Member States to contribute to efforts to end obstetric fistula, including, in particular, through the Campaign to End Fistula, as part of the endeavours to achieve Millennium Development Goal 5 by 2015, and to commit themselves to continue efforts to improve maternal health beyond 2015 with the aim of eliminating obstetric fistula globally;

Requests the Secretary-General to submit a report to the General Assembly at its seventy-first session on the implementation of the present resolution under the item entitled “Advancement of women”.

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