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Correspondence to Dr Carrie J Ngongo; cngongo@ gmail. com © Author(s) (or their employer(s)) 2023. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. LIVING WITH OBSTETRIC FISTULA: LEARNINGS FROM NINE AFRICAN COUNTRIES Narratives can be useful. Stories draw us in, inspiring empathy and action. Such is the case with obstetric fistula, a maternal morbidity that occurs when women experience obstructed labour and are not able to access a timely caesarean section. Women with fistula are left continuously leaking urine, an embarrassing and difficult problem that typically can be resolved only by surgery. On top of the physical and emotional suffering caused by fistula, these women also experience the loss of their children because most of their babies do not survive during labour. Although obstetric fistula is completely preventable, humanity has created and continues to tolerate a reality in which not all women share similar access to highquality healthcare. Obstetric fistula remains a challenge in rural settings in subSaharan Africa and South Asia where pregnant women do not have sufficient access to quality emergency obstetric care. Estimating fistula prevalence is challenging; perhaps one million women endure fistula, with 6000 new cases each year. The persisting burden of obstetric fistula reminds us of global health inequity, forcing us to see how health and social systems are failing to protect women and girls. Women with fistula face significant physical and social constraints. They endure the shame of smelling of urine, often without appropriate materials to manage their incontinence. Many live with interrelated physical and medical problems affecting their daily activities. The pain and stigma caused by fistula push affected women to avoid public gatherings and social events. Furthermore, women with fistula are more likely than others to experience domestic violence. Sexual intercourse can be painful or not possible. 6 It is a difficult reality for women and those who love them. Dramatic stories seemingly encapsulate the misery of living with obstetric fistula: women with fistula are shunned, abandoned and isolated. This most dramatic story is not true for all women with obstetric fistula, however. In a compelling TED Talk (Technology, Entertainment, Design), Adichie urges us to avoid the ‘danger of a single story’—narratives that become definitive, eliminating nuance and putting a wedge in our efforts to understand one another. Single stories are incomplete. They do not sufficiently reflect the diversity of experiences and perspectives that constitute reality. We wondered why some couples remain married through the ordeal of fistula while others do not. BMJ Open published our paper exploring this question: ‘Factors associated with marital status of women with genital fistula after childbirth: a retrospective review in nine African countries.’ It is a retrospective review that draws from a large, multicountry dataset of women who sought fistula repair surgery in nine African countries: Ethiopia, Kenya, Malawi, Rwanda, Somalia, South Sudan, Tanzania, Uganda and Zambia. TJIPR, MM and colleagues collected data from women who presented for fistula repair between 1994 and 2017 and had developed fistula between 1975 and 2017. Are all women with fistula divorced? No. Around 57% of the women included in our review were living with their husbands at the time that they sought fistula repair. Given that SUMMARY BOX