Geopolitical Instability and Maternal Health: Assessing the Impact on Obstetric Fistula Prevalence and Care in Low‐ and Middle‐Income Countries

Background: Obstetric fistula remains a major, yet preventable, maternal public health issue affecting tens of thousands of women annually—primarily in low- and middle-income countries (LMICs). It is intricately linked to health system failures, socio-economic inequality, and political instability. While advancements in maternal care have dramatically reduced maternal morbidity and mortality in high-income countries, progress has been inconsistent or stagnant across LMICs. The burden of obstetric fistula is exacerbated by ongoing conflict, reduced global aid, and weakened reproductive rights in many regions. Methods: This study explored historical and contemporary trends in maternal mortality and obstetric fistula, focusing on how geopolitical instability and global health policy shifts have shaped service delivery in low- and middle-income countries (LMICS). It assessed the effectiveness of international campaigns and training programmes while identifying systemic barriers and proposing evidence-based strategies to improve outcomes. A narrative review and policy analysis were conducted, drawing from peer-reviewed literature, global health databases (WHO, UNFPA, and World Bank), and grey literature spanning 1990–2025. Data included maternal mortality, fistula incidence, service models, and geopolitical events impacting healthcare systems. Key informant insights and case studies from conflict-affected regions—including Sudan, Afghanistan, and the DRC—were used to contextualise and strengthen the analysis. Results: Findings demonstrate a persistent and disproportionate burden of maternal mortality and obstetric fistula in sub-Saharan Africa and South Asia. Despite global campaigns (e.g., the UNFPA Campaign to End Fistula), the prevalence of untreated fistula remains high. Geopolitical instability, such as civil conflicts and forced migration, has directly undermined maternal healthcare infrastructure. Furthermore, structural adjustment policies, funding shifts toward disease-specific programmes, and the erosion of reproductive rights in several nations have hindered comprehensive maternal health provision. Capacity-building efforts, such as competency-based fistula surgery training endorsed by FIGO, have had localised success but are insufficiently scaled. Conclusion: Obstetric fistula is both a public health failure and a gender-based human rights issue, deeply rooted in structural inequities and geopolitical dynamics. Reductions in foreign aid, conflict-related health system collapse, and restrictive reproductive policies have collectively stalled progress. A multifaceted, rights-based approach—emphasising health system strengthening, midwifery-led care, patient empowerment, and geopolitical accountability—is urgently required. With coordinated investment and political will, the global community can reverse current trends and eliminate obstetric fistula as a public health problem.