Noting that public health response to obstetric fistula has been limited, the Gates Institute of the Johns Hopkins Bloomberg School of Public Health, WHO, UNFPA and FIGO co- sponsored in July 2005 an international meeting of over seventy scientists including clinicians, public health experts and epidemiologists. The objectives of the meeting, with representation from sixteen countries predominantly in sub-Saharan Africa, were to:
- advance the scientific knowledge on OF risks and treatment,
- prioritize research questions concerning public health responses to OF in the areas of prevention, rehabilitation and social integration,
- improve management in resource-poor settings and inform the public health response to OF.
A November 2007 special International Journal of Gynecology and Obstetrics (IJGO) supplement on OF resulted. It included 27 articles and an editorial that addressed the major meeting presentations documenting the needs in public health and clinical responses and actions, calling for actions tailored to reported country experiences and based on donor activities and commitments including the global Campaign to End Fistula. The editorial summarized the major agreements of the meeting: the need for a cooperative effort between clinicians and epidemiologists and the urgent need for a commonly accepted classification.
Based on the discussions from the meeting, this project was conceived. Considering significant heterogeneity in the types of fistula and service availability across the countries, it was planned to conduct the study in eight countries, seven in Africa (Benin, Ethiopia, Mali, Niger, Nigeria, Sudan and Tanzania) and one in Asia (Bangladesh). A meeting of PI and experts was convened at WHO Headquarter, Geneva, April 9-11, 2008, to discuss the study design, questionnaire and implementation plan. All the country PI’s participated in the meeting. In the meeting it was suggested to use the study data for developing a standardized classification system of fistula.
Johns Hopkins University, in collaboration with WHO, UNFPA, USAID and other professional gynecology/urogynecology societies, spearheaded the formation of the International Consortium of Obstetric Fistula Classification. The first meeting of the Consortium was held at WHO HQ, Geneva, March 24-25, 2009. The study data will be used for validating the classification system. WHO proposed that the next International Classification of Diseases (ICD-11) list the new classification system.