An effective approach to avoiding obstetric fistula must address the needs both for prevention and for treatment—especially where access to good obstetric services is limited. The problem of fistula is likely to endure until maternal health services reach the poorest and most vulnerable members of society (37). Before all women can receive adequate maternal care, a country’s health infrastructure often must improve substantially (50).

Three elements form the core of a comprehensive approach to addressing obstetric fistula (62, 63):

• Delaying pregnancies.
  
  Encouraging later marriage and delayed childbearing can help reduce the incidence of adolescent pregnancies and their risks.



• Improving access to obstetric care, including emergency care.
  
  Improving access to obstetric care is the most important step that can be taken to prevent fistula, in particular by avoiding the three stages of delay: (1) delay in deciding to seek care; (2) delay in reaching a health care facility; and (3) delay in receiving sufficient care at the facility.



• Providing surgical repair and counseling for women with fistula.
  
  Creating more specialized fistula repair centers, expanding the capacity of existing hospitals to provide repairs, establishing hostels for fistula patients, and training surgical and nursing staff are important components in successful fistula repair. Pre- and post- operative counseling and other reintegration services, such as literacy classes and job skills training, also provide valuable help for the fistula patient.

Reducing the number of adolescent pregnancies is one of the first steps to decreasing the frequency of pregnancy complications, including obstetric fistulas. As mentioned, most fistulas occur to adolescent girls, whose bodies may not be fully developed for childbearing (58).

	The Addis Ababa Fistula Hospital offers free treatment, housing, and counseling to all patients. Recovery after surgery generally takes two weeks.

Postponing age at first marriage, delaying age at first pregnancy, and spacing births further apart would help reduce complications of childbirth. Changes in traditions that encourage early marriage and childbearing would allow more young women to reach full physical maturity before beginning childbearing (71).

Helping women plan pregnancies is important to reducing the incidence of fistula. Many women living in rural areas, where fistula is most common, have little access to family planning information and services (63).

Strengthening the capacity of health care systems could improve family planning services to the rural poor. Better access to a range of contraceptive methods would help more people choose and continue using a method of their choice.

Offering more schooling and family life education for women also can help reduce obstetric fistulas (71). In particular, expanding health education and family planning programs will provide more women with information and services to delay childbearing until they are ready. Schooling helps young women raise their economic and social status and promotes maternal health (21).