Obstetric Fistula in Somalia: A Narrative Review of Burden, Lived Experience, Health-System Gaps, and Pathways to Elimination

Obstetric fistula is a preventable childbirth injury and an important marker of failure to provide timely, accessible, and high-quality emergency obstetric care. In Somalia, direct epidemiological evidence remains limited, but the available literature documents fistula related to prolonged obstructed labor, delayed access to repair, iatrogenic injury, low awareness, and profound social consequences. This narrative review synthesizes indexed evidence on obstetric fistula in Somalia and relevant regional literature, with emphasis on burden, pathways to injury, healthcare delays, women's decision-making autonomy, treatment barriers, surgical outcomes, rehabilitation, and prevention. A focused search of PubMed/MEDLINE and Scopus was updated through August 8, 2026. Only peer-reviewed journal articles indexed in PubMed/MEDLINE or Scopus were included. Somalia-specific studies were prioritized, while high-quality regional and global evidence was used where local data were insufficient. The literature indicates that fistula in Somalia should be understood as the end result of interacting clinical and health-system failures rather than as an isolated surgical condition. Prolonged obstructed labor remains the central pathway, while limited antenatal care, referral barriers, delayed emergency cesarean delivery, financial and geographic constraints, restricted healthcare decision-making for some women, and inadequate access to specialist repair can extend preventable morbidity. A sustainable response requires prevention of new cases, early detection, rapid referral, respect for women's informed consent, year-round repair capacity, functional continence assessment, psychosocial and reproductive rehabilitation, and national outcome surveillance. Somalia-specific research should now move beyond treatment-seeking samples toward population-based burden estimates, prospective studies of emergency obstetric delays, standardized surgical outcome reporting, and long-term follow-up after repair.