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Since the launch, in 2015, of the $207 million initiative, national programmes that promote fistula prevention, including those focusing on generating demand for maternal and newborn health, empowering women and girls, preventing early marriages, keeping girls in school and increasing the availability of trained health workers, including midwives, are well under way. 22. (...) In 2017, the Rohingya refugee crisis intensified, bringing to the fore the need for emergency obstetric and newborn care, as well as skilled attendants at birth, for refugee women and girls in crisis. (...) In 2017, 100 midwives deployed to humanitarian situations screened 110,000 women and girls, distributed some 4,000 clean delivery kits , conducted more than 30,000 antenatal care check-ups, 3,000 post-natal care check- ups and 1,300 deliveries in facilities, and referred over 200 obstetric emergencies, thus contributing to saving maternal and newborn lives and averting fistula.

Prevention efforts also include improved quality of maternal health care, education and empowerment of women and girls, addressing economic and sociocultural factors that negatively affect women and girls, engaging men and boys and empowering communities. (...) The compounding of the violation of girls’ rights can only be redressed through targeted investments in empowerment for girls, access to quality health services, information and education, including comprehensive health and human rights education (including comprehensive sexuality education) for adolescent girls and boys. (...) Since 2015, the Project has strengthened national programmes that promote fistula prevention, including those focusing on generating demand for maternal and newborn health, empowering women and girls, preventing early marriages, and increasing availability of trained health workers, including midwives.

Obstetric fistula is a devastating childbirth injury that leaves women and girls incontinent and often stigmatized and isolated from their families and communities. (...) Ending obstetric fistula is fundamental to reducing maternal mortality and morbidity and improving maternal and newborn health. Any woman or girl suffering from prolonged obstructed labour without timely access to an emergency Caesarean section is at high risk of developing obstetric fistula. (...) Impoverished, marginalized girls are more likely to be subjected to child marriage and become pregnant than girls who have greater education and economic opportunities. 6 All adolescent girls and boys, both in and out of school, need access to health services, including those relating to sexual and reproductive health, to protect their well -being. 8.

A/C.3/73/L.20 18-17401 2/8 Reaffirming also the Universal Declaration of Human Rights,8 the Convention on the Elimination of All Forms of Discrimination against Women 9 and the Convention on the Rights of the Child, 10 recalling the International Covenant on Economic, Social and Cultural Rights,11 and urging States that have not done so to consider, as a matter of priority, signing, ratifying or acceding to those conventions and the optional protocols thereto, Taking note of the report of the Secretary-General12 and the conclusions and recommendations contained therein, Recognizing that intensified national ownership and leadership, political commitment and scaled-up national capacity are urgently needed to accelerate progress towards the elimination of fistula, including by implementing strategie s to prevent new cases and treating all existing cases, with special attention paid to countries with the highest maternal mortality and morbidity levels, Stressing the interlinkages between poverty, malnutrition, lack of or inadequate or inaccessible health-care services, early childbearing and adolescent pregnancy, child, early and forced marriage, violence against young women and girls, sociocultural barriers, marginalization, illiteracy and gender inequality as root causes of obstetric fistula, and that poverty remains the main social risk factor, Recognizing that the difficult socioeconomic conditions that exist in many developing countries, in particular the least developed countries, have resulted in the acceleration of the feminization of poverty, Recognizing also that early childbearing and adolescent pregnancy increase the risk of complications during pregnancy and childbirth and entail a much higher risk of maternal mortality and morbidity, and deeply concerned that early childbearing, adolescent pregnancy and limited access to the highest attainable standard of mental and physical health, including sexual and reproductive health, specifically timely access to high-quality emergency obstetric care, cause high levels of obstetric fistula and other maternal morbidities, as well as maternal mortality, Recognizing further that adolescent girls, in particular those who are impoverished and marginalized, are at particular risk of maternal death and morbidity, including obstetric fistula, and concerned that the leading cause of death among girls aged 15 to 19 in many low- and middle-income countries is complications from pregnancy and childbirth and that women aged 30 and older are at increased risk of developing complications and of dying during childbirth, Recognizing that lack of access to sexual and reproductive health, especially emergency obstetric services, remains among the leading causes of obstetric fistula, leading to ill health and death for women and girls of childbearing age in many regions of the world, and that a dramatic and sustainable scaling-up of quality treatment and health-care services, including high quality emergency obstetric services, and of the number of trained, competent fistula surgeons and midwives is needed to significantly reduce maternal and newborn mortality and to eradicate obstetric fistula, Noting that a human rights-based approach to eliminating obstetric fistula and efforts to eliminate obstetric fistula should be underpinned by the principles of, inter __________________ 8 Resolution 217 A (III). 9 United Nations, Treaty Series, vol. 1249, No. 20378. 10 Ibid., vol. 1577, No. 27531. 11 See resolution 2200 A (XXI), annex. 12 A/73/285. (...) Further calls upon States to ensure the right to education of good quality for women and girls, on an equal basis with men and boys, and to ensure that they complete a full course of primary education, and to renew their efforts to improve and expand education for women and girls at all levels, including at the secondary and higher levels, including age-appropriate sex education, as well as vocational education and technical training, in order to, inter alia, achieve gender equality, the economic empowerment of women and girls and poverty eradication; 6. (...) Calls upon States and/or the relevant funds and programmes, organs and the specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector, to end obstetric fistula within a decade by: (a) Redoubling their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high-quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care; (b) Making greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health-care services and ensure that women and girls have access to the full cont inuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery; A/C.3/73/L.20 18-17401 6/8 (c) Supporting the training of doctors and surgeons, nurses and other health - care workers in lifesaving obstetric care, especially midwives, who are the front-line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, including training on fistula prevention, treatment and care as a standard element of the training curricula of health professionals; (d) Ensuring universal access through national policies, plans and programmes that make maternal and newborn health-care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible and affordable, including in rural and remote areas and among the poorest women and girls through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula; (e) Developing, implementing, following up on and supporting national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula within a decade developing further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, which is preventable, including by ensuring access to affordable, accessible, comprehensive, high-quality maternal health-care services, and, within countries, incorporating into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor, vulnerable women and girls; (f) Establishing or strengthening, as appropriate, a national task force for obstetric fistula, with a lead governmental entity, to enhance national coordination and improve partner collaboration to end obstetric fistula, including by partnering with in-country efforts to increase surgical capacity and promote universal access to essential and life-saving surgery; (g) Strengthening the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obstet ric fistula and to treat existing cases by increasing national budgets for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of tr ained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled “Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development”, which provides background information and principles for developing fistula prevention and treatment programmes, as appropriate; (h) Mobilizing funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well-being and survival and to prevent the recurrence of subsequent fistulas by making post-surgery follow-up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula A/C.3/73/L.20 7/8 18-17401 survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies; (i) Increasing national budgets and harnessing national resources for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula and strengthening the capacity of health-care systems to provide the essential services to prevent obstetric fistula and to treat existing cases; (j) Strengthening partnerships, including regional initiatives and collaboration, and significantly increasing international financial commitments to end fistula within a decade and to achieve the Sustainable Development Goals; (k) Intensifying efforts to mobilize resources for the global Campaign to End Fistula in order to address the declining contributions to the Campaign and meet the current needs of countries; (l) Ensuring that all women and girls who have undergone fistula treatment, including the forgotten women and girls whose conditions are deemed incurab le or inoperable, are provided with and have access to comprehensive health-care services, holistic social integration services and careful follow-up, including counselling, education, family planning and socioeconomic empowerment, for as long as needed, through, inter alia, skills development and income-generating activities, so that they can overcome abandonment, stigma, ostracism, and social exclusion, and developing linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal; (m) Empowering fistula survivors to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival; (n) Accelerating efforts to improve the health of women and girls globally, with an increased focus on social determinants that affect their well -being, which include the provision of universal education for women and girls, economic empowerment, with access to microcredit, savings and microfinancing, legal reforms, and social initiatives, including legal literacy to protect women and girls from violence and discrimination, child marriage and early pregnancy; (o) Educating individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevented and treated, and increasing awareness of the needs of pregnant women and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of mental and physical health, including sexual and reproductive health, by working with local community and religious leaders, traditional birth attendants and midwives, women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers; (p) Enhancing the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and further strengthening their involvement as partners, including in the global Campaign to End Fistula; (q) Strengthening awareness-raising and advocacy, including through the media and schools, to effectively reach women, young boys and girls, families and communities with key messages on fistula prevention and treatment and social reintegration; (r) Strengthening research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric A/C.3/73/L.20 18-17401 8/8 fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes and ending fistula within a decade; (s) Strengthening research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near- miss cases as part of a national maternal death surveillance and response system, integrated within national health information systems; (t) Improving data collection, pre- and post-surgery, to measure progress in addressing needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health-related complications, so as to address the challenges of improving maternal health; (u) Providing essential health-care services, equipment and supplies, education, skills training and income-generating projects and support to women and girls so that they can break out of the cycle of poverty; 15.

Intensification of efforts to end obstetric fistula A/RES/75/159 3/8 20-17294 emergency obstetric services, and of the number of trained, competent fistula surgeons and midwives is needed to significantly reduce maternal and newborn mortality and to eradicate obstetric fistula, Noting that a human rights-based approach to eliminating obstetric fistula and efforts to eliminate obstetric fistula should be underpinned by, inter alia, accountability, participation, transparency, empowerment, sustainability, non-discrimination and international cooperation, Deeply concerned about discrimination against and marginalization of women and girls, in particular those who are facing multiple and intersecting forms of discrimination, which often result in reduced access to education and nutrition, compromising their physical and mental health and well-being and the enjoyment of their human rights and the opportunities and benefits of childhood and adolescence compared with boys, and often in their being subjected to various forms of cultural, social, sexual and economic exploitation and abuse, violence and harmful practices, which can increase the risk of obstetric fistula, Deeply concerned also about the situation of women and girls living with or recovering from obstetric fistula, who are often neglected and stigmatized, which may lead to negative effects on their mental health, resulting in depression and suicide, and are driven deeper into poverty and marginalization, Recognizing the need to raise awareness among men and adolescent boys and, in this context, to fully engage men and community leaders as strategic partners and allies in the efforts to address and eliminate obstetric fistula, Welcoming the contribution by Member States, the international community, the private sector and civil society to the global Campaign to End Fistula led by the United Nations Population Fund, bearing in mind that a people-centred approach to social and economic development is fundamental for protecting and empowering individuals and communities, Deeply concerned that, as the global Campaign to End Fistula completes its seventeenth anniversary, while some progress has been made, significant challenges remain that require the intensification of efforts at all levels to end obstetric fistula, Deeply concerned also about the insufficient resources for addressing obstetric fistula in high-burden countries, compounded by the low levels of development assistance for maternal and newborn health, which have declined in recent years, and the substantial need for additional resources and support for the global Campaign to End Fistula and for national and regional initiatives dedicated to improving maternal health and eliminating obstetric fistula, Noting the Secretary-General’s revised Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), undertaken by a broad coalition of partners, in support of national plans and strategies that aim for the highest attainable standards of health and well-being, physical, mental and social, at every age, ending maternal and newborn mortality, which is preventable, and noting that this can contribute to the achievement of the Sustainable Development Goals, Welcoming the various national, regional and international initiatives on all the Sustainable Development Goals and the global Campaign to End Fistula, including those undertaken bilaterally and through South-South cooperation, in support of national plans and strategies in sectors such as health, education, finance, gender equality, energy, water and sanitation, poverty eradication and nutrition as a way to reduce the number of maternal, newborn and under-5 child deaths, Welcoming also ongoing partnerships between stakeholders at all levels to address the multifaceted determinants of maternal, newborn and child health, in close A/RES/75/159 Intensification of efforts to end obstetric fistula 20-17294 4/8 coordination with Member States, based on their needs and priorities, and in this regard welcoming further the commitments to accelerate progress on the health - related Sustainable Development Goals by 2030, 1. (...) Further calls upon States to ensure the right to education of good quality for women and girls, on an equal basis with men and boys, and to ensure that they complete a full course of primary education, and to renew their efforts to improve and expand girls’ and women’s education at all levels, including at the secondary and higher levels, including age-appropriate sex education, as well as vocational education and technical training, in order to, inter alia, achieve gen der equality, the empowerment of women and girls and poverty eradication; 6. (...) Calls upon States and/or the relevant funds and programmes, organs and specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector, to end obstetric fistula within a decade by: (a) Redoubling their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high-quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care; (b) Making greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health-care services and ensure that women and girls have access to the full continuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery; (c) Supporting the training of doctors and surgeons, nurses and other health - care workers in life-saving obstetric care, especially midwives, who are the front-line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, A/RES/75/159 Intensification of efforts to end obstetric fistula 20-17294 6/8 including training on fistula prevention, treatment and care as a standard element of the training curricula of health professionals; (d) Ensuring universal access through national policies, plans and programmes that make maternal and newborn health-care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible and affordable, including in rural and remote areas and among the poorest women and girls through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, support for developing and maintaining infrastructure to improve maternal and newborn health-care services and to strengthen the capacity for surgery, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula; (e) Developing, implementing, following up on and supporting national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula within a decade by developing further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, which is preventable and treatable, including by ensuring access to affordable, accessible, comprehensive, high-quality maternal health-care services, and, within countries, incorporating into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor women and girls and those in vulnerable situations; (f) Establishing or strengthening, as appropriate, a national task force for obstetric fistula, with a lead governmental entity, to enhance national coordination and improve partner collaboration to end obstetric fistula, including partnering with in-country efforts, to increase surgical capacity and to promote universal access to essential and life-saving surgery; (g) Strengthening the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obstetric fistula and to treat existing cases by increasing national budgets for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of trained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development, which provides background information and principles for developing fistula prevention and treatment programmes, as appropriate; (h) Mobilizing funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well -being and survival and to prevent the recurrence of subsequent fistulas by making post-surgery follow-up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies; Intensification of efforts to end obstetric fistula A/RES/75/159 7/8 20-17294 (i) Increasing national budgets and harnessing domestic resources for health, ensuring that adequate funds are allocated to prevent obstetric fistula and to treat existing cases, and for strengthening the capacity of health -care systems to provide the essential services needed in this regard; (j) Ensuring that all women and girls who have undergone fistula treatment, including the forgotten women and girls whose conditions are deemed incurable or inoperable, are provided with and have access to comprehensive health-care services, holistic social integration services and careful follow-up, including counselling, education, family planning, socioeconomic empowerment, social protection and psychosocial services, for as long as needed, through, inter alia, skills development, family and community support and income-generating activities, so that they can overcome abandonment, stigma, ostracism and economic and social exclusion, and developing linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal; (k) Empowering fistula survivors to make informed decisions about their lives and to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival, and supporting the exercise of their voice, agency and leadership; (l) Accelerating efforts to improve the health of women and girls globally, with an increased focus on social determinants that affect their well-being and that include the provision of universal access to quality education for women and girls, economic empowerment, with access to microcredit, savings and microfinancing, legal reforms, the promotion and support of their meaningful participation in decision-making at all levels, and social initiatives, including legal literacy to protect women and girls from violence and discrimination, child, early and forced marriage and early pregnancy; (m) Educating individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevented and treated, and increasing awareness of the needs of pregnant women and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of mental and physical health, including sexual and reproductive health, by working with community and religious leaders, traditional birth attendants and midwives, women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers; (n) Enhancing the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and further strengthening their involvement as partners, including in the global Campaign to End Fistula; (o) Strengthening awareness-raising and advocacy, including through the media, to effectively reach families and communities with key messages on fistula prevention and treatment and social reintegration; (p) Strengthening research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes and ending fistula within a decade; (q) Strengthening research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near-miss A/RES/75/159 Intensification of efforts to end obstetric fistula 20-17294 8/8 cases as part of a national maternal death surveillance and response system, integrated within national health information systems; (r) Improving data collection, pre- and post-surgery, to measure progress in addressing needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health-related complications, so as to address the challenges of improving maternal health; (s) Providing essential health-care services, equipment and supplies, education, skills training and income-generating projects and support to women and girls so that they can break out of the cycle of poverty; 15.

Intensification of efforts to end obstetric fistula A/RES/73/147 3/8 18-22184 of childbearing age in many regions of the world, and that a dramatic and sustainable scaling-up of quality treatment and health-care services, including high-quality emergency obstetric services, and of the number of trained, competent fistula surgeons and midwives is needed to significantly reduce maternal and newborn mortality and to eradicate obstetric fistula, Noting that a human rights-based approach to eliminating obstetric fistula and efforts to eliminate obstetric fistula should be underpinned by, inter alia, accountability, participation, transparency, empowerment, sustainability, non-discrimination and international cooperation, Deeply concerned about discrimination against and marginalization of women and girls, in particular those who are facing multiple and intersecting forms of discrimination, which often result in reduced access to education and nut rition, compromising their physical and mental health and well-being and the enjoyment of their human rights and the opportunities and benefits of childhood and adolescence compared with boys, and often in their being subjected to various forms of cultural , social, sexual and economic exploitation and abuse, violence and harmful practices, which can increase the risk of obstetric fistula, Deeply concerned also about the situation of women and girls living with or recovering from obstetric fistula, who are often neglected and stigmatized, which may lead to negative effects on their mental health, resulting in depression and suicide, and are driven deeper into poverty and marginalization, Recognizing the need to raise awareness among men and adolescent boys and, in this context, to fully engage men and community leaders as strategic partners and allies in the efforts to address and eliminate obstetric fistula, Welcoming the contribution by Member States, the international community, the private sector and civil society to the global Campaign to End Fistula led by the United Nations Population Fund, bearing in mind that a people -centred approach to social and economic development is fundamental for protecting and empowering individuals and communities, Deeply concerned that, as the global Campaign to End Fistula completes its fifteenth anniversary, while some progress has been made, significant challenges remain that require the intensification of efforts at all levels to end obstetric fistula, Deeply concerned also about the insufficient resources for addressing obstetric fistula in high-burden countries, compounded by the low levels of development assistance for maternal and newborn health, which have declined in recent years, and the substantial need for additional resources and support for the global Campaign to End Fistula and for national and regional initiatives dedicated to improving maternal health and eliminating obstetric fistula, Noting the Secretary-General’s revised Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), undertaken by a broad coalition of partners, in support of national plans and strategies that aim for the highest attainable standards of health and well-being, physical, mental and social, at every age, ending maternal and newborn mortality, which is preventable, and noting that this can contribute to the achievement of the Sustainable Development Goals, Welcoming the various national, regional and international initiatives on all the Sustainable Development Goals and the global Campaign to End Fistula, including those undertaken bilaterally and through South-South cooperation, in support of national plans and strategies in sectors such as health, education, finance, gender equality, energy, water and sanitation, poverty eradication and nutrition as a way to reduce the number of maternal, newborn and under-5 child deaths, A/RES/73/147 Intensification of efforts to end obstetric fistula 18-22184 4/8 Welcoming also ongoing partnerships between stakeholders at all levels to address the multifaceted determinants of maternal, newborn and child health, in close coordination with Member States, based on their needs and priorities, and in this regard welcoming further the commitments to accelerate progress on the health - related Sustainable Development Goals by 2030, 1. (...) Further calls upon States to ensure the right to education of good quality for women and girls, on an equal basis with men and boys, and to ensure that they complete a full course of primary education, and to renew their efforts to improve and expand girls’ and women’s education at all levels, including at the secondary and higher levels, including age-appropriate sex education, as well as vocational education and technical training, in order to, inter alia, achieve gender equality, the empowerment of women and girls and poverty eradication; 6. (...) Calls upon States and/or the relevant funds and programmes, organs and the specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector, to end obstetric fistula within a decade by: (a) Redoubling their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high-quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care; (b) Making greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, A/RES/73/147 Intensification of efforts to end obstetric fistula 18-22184 6/8 gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health-care services and ensure that women and girls have access to the full continuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery; (c) Supporting the training of doctors and surgeons, nurses and other health - care workers in life-saving obstetric care, especially midwives, who are the front-line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, including training on fistula prevention, treatment and care as a standard element of the training curricula of health professionals; (d) Ensuring universal access through national policies, plans and programmes that make maternal and newborn health-care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible and affordable, including in rural and remote areas and among the poorest women and girls through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, support for developing and maintaining infrastructure to improve maternal and newborn health-care services and to strengthen the capacity for surgery, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula; (e) Developing, implementing, following up on and supporting national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula within a decade by developing further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, which is preventable and treatable, including by ensuring access to affordable, accessible, comprehensive, high-quality maternal health-care services, and, within countries, incorporating into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor women and girls and those in vulnerable situations; (f) Establishing or strengthening, as appropriate, a national task force for obstetric fistula, with a lead governmental entity, to enhance national coordination and improve partner collaboration to end obstetric fistula, including partnering with in-country efforts, to increase surgical capacity and to promote universal access to essential and life-saving surgery; (g) Strengthening the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obste tric fistula and to treat existing cases by increasing national budgets for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of t rained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development, which provides background information Intensification of efforts to end obstetric fistula A/RES/73/147 7/8 18-22184 and principles for developing fistula prevention and treatment programmes, as appropriate; (h) Mobilizing funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well-being and survival and to prevent the recurrence of subsequent fistulas by making post-surgery follow- up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies; (i) Increasing national budgets and harnessing domestic resources for health, ensuring that adequate funds are allocated to prevent obstetric fistula and to treat existing cases, and for strengthening the capacity of health-care systems to provide the essential services needed in this regard; (j) Ensuring that all women and girls who have undergone fistula treatment, including the forgotten women and girls whose conditions are deemed incurable or inoperable, are provided with and have access to comprehensive health-care services, holistic social integration services and careful follow-up, including counselling, education, family planning, socioeconomic empowerment, social protection and psychosocial services, for as long as needed, through, inter alia, skills development, family and community support and income-generating activities, so that they can overcome abandonment, stigma, ostracism and economic and social exclusion, and developing linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal; (k) Empowering fistula survivors to make informed decisions about their lives and to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival, and supporting the exercise of their voice, agency and leadership; (l) Accelerating efforts to improve the health of women and girls globally, with an increased focus on social determinants that affect their well -being and that include the provision of universal access to quality education for women and girls, economic empowerment, with access to microcredit, savings and microfinancing, legal reforms, the promotion and support of their meaningful participation in decision-making at all levels, and social initiatives, including legal literacy to protect women and girls from violence and discrimination, child, early and forced marriage and early pregnancy; (m) Educating individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevented and treated, and increasing awareness of the needs of pregnant women and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of mental and physical health, including sexual and reproductive health, by working with community and religious leaders, traditional birth attendants and midwives, women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers; (n) Enhancing the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and further strengthening their involvement as partners, including in the global Campaign to End Fistula; A/RES/73/147 Intensification of efforts to end obstetric fistula 18-22184 8/8 (o) Strengthening awareness-raising and advocacy, including through the media, to effectively reach families and communities with key messages on fistula prevention and treatment and social reintegration; (p) Strengthening research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes and ending fistula within a decade; (q) Strengthening research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near- miss cases as part of a national maternal death surveillance and response system, integrated within national health information systems; (r) Improving data collection, pre- and post-surgery, to measure progress in addressing needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health-related complications, so as to address the challenges of improving maternal health; (s) Providing essential health-care services, equipment and supplies, education, skills training and income-generating projects and support to women and girls so that they can break out of the cycle of poverty; 15.

A/C.3/75/L.17 3/8 20-13876 pregnancy and childbirth and that women aged 30 and older are at increased risk of developing complications and of dying during childbirth, Recognizing that lack of access to sexual and reproductive health, especially emergency obstetric, services, including in humanitarian settings, remains among the leading causes of obstetric fistula, leading to ill health and death for women and girls of childbearing age in many regions of the world, and that a dramatic and sustainable scaling-up of quality treatment and health-care services, including high-quality emergency obstetric services, and of the number of trained, competent fistula surgeons and midwives is needed to significantly reduce maternal and newborn mortality and to eradicate obstetric fistula, Noting that a human rights-based approach to eliminating obstetric fistula and efforts to eliminate obstetric fistula should be underpinned by, inter alia, accountability, participation, transparency, empowerment, sustainability, non-discrimination and international cooperation, Deeply concerned about discrimination against and marginalization of women and girls, in particular those who are facing multiple and intersecting forms of discrimination, which often result in reduced access to education and nutrition, compromising their physical and mental health and well-being and the enjoyment of their human rights and the opportunities and benefits of childhood and adolescence compared with boys, and often in their being subjected to various forms of cultural, social, sexual and economic exploitation and abuse, violence and harmful practices, which can increase the risk of obstetric fistula, Deeply concerned also about the situation of women and girls living with or recovering from obstetric fistula, who are often neglected and stigmatized, which may lead to negative effects on their mental health, resulting in depression and suicide, and are driven deeper into poverty and marginalization, Recognizing the need to raise awareness among men and adolescent boys and, in this context, to fully engage men and community leaders as strategic partners and allies in the efforts to address and eliminate obstetric fistula, Welcoming the contribution by Member States, the international community, the private sector and civil society to the global Campaign to End Fistula led by the United Nations Population Fund, bearing in mind that a people-centred approach to social and economic development is fundamental for protecting and empowering individuals and communities, Deeply concerned that, as the global Campaign to End Fistula completes its seventeenth anniversary, while some progress has been made, significant challenges remain that require the intensification of efforts at all levels to end obstetric fistula, Deeply concerned also about the insufficient resources for addressing obstetric fistula in high-burden countries, compounded by the low levels of development assistance for maternal and newborn health, which have declined in recent years, and the substantial need for additional resources and support for the global Campaign to End Fistula and for national and regional initiatives dedicated to improving maternal health and eliminating obstetric fistula, Noting the Secretary-General’s revised Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), undertaken by a broad coalition of partners, in support of national plans and strategies that aim for the highest attainable standards of health and well-being, physical, mental and social, at every age, ending maternal and newborn mortality, which is preventable, and noting that this can contribute to the achievement of the Sustainable Development Goals, A/C.3/75/L.17 20-13876 4/8 Welcoming the various national, regional and international initiatives on all the Sustainable Development Goals and the global Campaign to End Fistula, including those undertaken bilaterally and through South-South cooperation, in support of national plans and strategies in sectors such as health, education, finance, gender equality, energy, water and sanitation, poverty eradication and nutrition as a way to reduce the number of maternal, newborn and under-5 child deaths, Welcoming also ongoing partnerships between stakeholders at all levels to address the multifaceted determinants of maternal, newborn and child health, in close coordination with Member States, based on their needs and priorities, and in this regard welcoming further the commitments to accelerate progress on the health- related Sustainable Development Goals by 2030, 1. (...) Further calls upon States to ensure the right to education of good quality for women and girls, on an equal basis with men and boys, and to ensure that they complete a full course of primary education, and to renew their efforts to improve and expand girls’ and women’s education at all levels, including at the secondary and higher levels, including age-appropriate sex education, as well as vocational education and technical training, in order to, inter alia, achieve gender equality, the empowerment of women and girls and poverty eradication; 6. (...) Calls upon States and/or the relevant funds and programmes, organs and specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector, to end obstetric fistula within a decade by: (a) Redoubling their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric A/C.3/75/L.17 20-13876 6/8 fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high-quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care; (b) Making greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health-care services and ensure that women and girls have access to the full continuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery; (c) Supporting the training of doctors and surgeons, nurses and other health- care workers in life-saving obstetric care, especially midwives, who are the front-line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, including training on fistula prevention, treatment and care as a standard element of the training curricula of health professionals; (d) Ensuring universal access through national policies, plans and programmes that make maternal and newborn health-care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible and affordable, including in rural and remote areas and among the poorest women and girls through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, support for developing and maintaining infrastructure to improve maternal and newborn health-care services and to strengthen the capacity for surgery, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula; (e) Developing, implementing, following up on and supporting national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula within a decade by developing further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, which is preventable and treatable, including by ensuring access to affordable, accessible, comprehensive, high-quality maternal health-care services, and, within countries, incorporating into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor women and girls and those in vulnerable situations; (f) Establishing or strengthening, as appropriate, a national task force for obstetric fistula, with a lead governmental entity, to enhance national coordination and improve partner collaboration to end obstetric fistula, including partnering with in-country efforts, to increase surgical capacity and to promote universal access to essential and life-saving surgery; (g) Strengthening the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obstetric fistula and to treat existing cases by increasing national budgets for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of trained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls A/C.3/75/L.17 7/8 20-13876 awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development, which provides background information and principles for developing fistula prevention and treatment programmes, as appropriate; (h) Mobilizing funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well-being and survival and to prevent the recurrence of subsequent fistulas by making post-surgery follow- up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies; (i) Increasing national budgets and harnessing domestic resources for health, ensuring that adequate funds are allocated to prevent obstetric fistula and to treat existing cases, and for strengthening the capacity of health-care systems to provide the essential services needed in this regard; (j) Ensuring that all women and girls who have undergone fistula treatment, including the forgotten women and girls whose conditions are deemed incurable or inoperable, are provided with and have access to comprehensive health-care services, holistic social integration services and careful follow-up, including counselling, education, family planning, socioeconomic empowerment, social protection and psychosocial services, for as long as needed, through, inter alia, skills development, family and community support and income-generating activities, so that they can overcome abandonment, stigma, ostracism and economic and social exclusion, and developing linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal; (k) Empowering fistula survivors to make informed decisions about their lives and to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival, and supporting the exercise of their voice, agency and leadership; (l) Accelerating efforts to improve the health of women and girls globally, with an increased focus on social determinants that affect their well-being and that include the provision of universal access to quality education for women and girls, economic empowerment, with access to microcredit, savings and microfinancing, legal reforms, the promotion and support of their meaningful participation in decision-making at all levels, and social initiatives, including legal literacy to protect women and girls from violence and discrimination, child, early and forced marriage and early pregnancy; (m) Educating individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevented and treated, and increasing awareness of the needs of pregnant women and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of mental and physical health, including sexual and reproductive health, by working with community and religious leaders, traditional birth attendants and midwives, women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers; A/C.3/75/L.17 20-13876 8/8 (n) Enhancing the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and further strengthening their involvement as partners, including in the global Campaign to End Fistula; (o) Strengthening awareness-raising and advocacy, including through the media, to effectively reach families and communities with key messages on fistula prevention and treatment and social reintegration; (p) Strengthening research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes and ending fistula within a decade; (q) Strengthening research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near- miss cases as part of a national maternal death surveillance and response system, integrated within national health information systems; (r) Improving data collection, pre- and post-surgery, to measure progress in addressing needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health-related complications, so as to address the challenges of improving maternal health; (s) Providing essential health-care services, equipment and supplies, education, skills training and income-generating projects and support to women and girls so that they can break out of the cycle of poverty; 15.

A/C.3/73/L.20/Rev.1 3/8 18-19369 of childbearing age in many regions of the world, and that a dramatic and sustainable scaling-up of quality treatment and health-care services, including high quality emergency obstetric services, and of the number of trained, competent fistula surgeons and midwives is needed to significantly reduce maternal and newborn mortality and to eradicate obstetric fistula, Noting that a human rights-based approach to eliminating obstetric fistula and efforts to eliminate obstetric fistula should be underpinned by, inter alia, accountability, participation, transparency, empowerment, sustainability, non- discrimination and international cooperation, Deeply concerned about discrimination against and marginalization of women and girls, in particular those who are facing multiple and intersecting forms of discrimination, which often result in reduced access to education and nutrition, compromising their physical and mental health and well-being and the enjoyment of their human rights and the opportunities and benefits of childhood and adolescence compared with boys, and often in their being subjected to various forms of cultural, social, sexual and economic exploitation and abuse, violence and harmful practices, which can increase the risk of obstetric fistula, Deeply concerned also about the situation of women and girls living with or recovering from obstetric fistula, who are often neglected and stigmatized, which may lead to negative effects on their mental health, resulting in depression and suicide, and are driven deeper into poverty and marginalization, Recognizing the need to raise awareness among men and adolescent boys and, in this context, to fully engage men and community leaders as strategic partners and allies in the efforts to address and eliminate obstetric fistula, Welcoming the contribution by Member States, the international community, the private sector and civil society to the global Campaign to End Fistula led by the United Nations Population Fund, bearing in mind that a people -centred approach to social and economic development is fundamental for protecting and empowering individuals and communities, Deeply concerned that, as the global Campaign to End Fistula completes its fifteenth anniversary, while some progress has been made, significant challenges remain that require the intensification of efforts at all levels to end obstetric fistula, Deeply concerned also about the insufficient resources for addressing obstetric fistula in high-burden countries, compounded by the low levels of development assistance for maternal and newborn health, which have declined in recent years, and the substantial need for additional resources and support for the global Campaign to End Fistula and for national and regional initiatives dedicated to improving maternal health and eliminating obstetric fistula, Noting the Secretary-General’s revised Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), undertaken by a broad coalition of partners, in support of national plans and strategies that aim for the highest attainable standards of health and well-being, physical, mental and social, at every age, ending maternal and newborn mortality, which is preventable, and noting that this can contribute to the achievement of the Sustainable Development Goals, Welcoming the various national, regional and international initiatives on all the Sustainable Development Goals and the global Campaign to End Fistula, including those undertaken bilaterally and through South-South cooperation, in support of national plans and strategies in sectors such as health, education, finance, gender equality, energy, water and sanitation, poverty eradication and nutrition as a way to reduce the number of maternal, newborn and under-five child deaths, A/C.3/73/L.20/Rev.1 18-19369 4/8 Welcoming also ongoing partnerships between stakeholders at all levels to address the multifaceted determinants of maternal, newborn and child health, in close coordination with Member States, based on their needs and priorities, and in this regard welcoming further the commitments to accelerate progress on the health- related Sustainable Development Goals by 2030, 1. (...) Further calls upon States to ensure the right to education of good quality for women and girls, on an equal basis with men and boys, and to ensure that they complete a full course of primary education, and to renew their efforts to improve and expand girls’ and women’s education at all levels, including at the secondary and higher levels, including age-appropriate sex education, as well as vocational education and technical training, in order, inter alia, to achieve gender equality, the empowerment of women and girls and poverty eradication; 6. (...) Calls upon States and/or the relevant funds and programmes, organs and the specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector, to end obstetric fistula within a decade by: (a) Redoubling their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high-quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care; (b) Making greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, A/C.3/73/L.20/Rev.1 18-19369 6/8 gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health-care services and ensure that women and girls have access to the full continuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery; (c) Supporting the training of doctors and surgeons, nurses and other health - care workers in lifesaving obstetric care, especially midwives, who are the front -line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, including training on fistula prevention, treatment and care as a standard element of the training curricula of health professionals; (d) Ensuring universal access through national policies, plans and programmes that make maternal and newborn health-care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible and affordable, including in rural and remote areas and among the poorest women and girls through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, support for developing and maintaining infrastructure to improve maternal and newborn health-care services and to strengthen the capacity for surgery, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula; (e) Developing, implementing, following up on and supporting national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula within a decade by developing further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, which is preventable and treatable, including by ensuring access to affordable, accessible, comprehensive, high-quality maternal health-care services, and, within countries, incorporating into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor women and girls and those in vulnerable situations; (f) Establishing or strengthening, as appropriate, a national task force for obstetric fistula, with a lead governmental entity, to enhance national coordination and improve partner collaboration to end obstetric fistula, including partnering with in-country efforts, to increase surgical capacity and to promote universal access to essential and life-saving surgery; (g) Strengthening the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obstetric fistula and to treat existing cases by increasing national budgets for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of trained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled “Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development”, which provides background A/C.3/73/L.20/Rev.1 7/8 18-19369 information and principles for developing fistula prevention and treatment programmes, as appropriate; (h) Mobilizing funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well-being and survival and to prevent the recurrence of subsequent fistulas by making post -surgery follow- up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies; (i) Increasing national budgets and harnessing domestic resources for health, ensuring that adequate funds are allocated to prevent obstetric fistula and to treat existing cases, and for strengthening the capacity of health-care systems to provide the essential services needed in this regard; (j) Ensuring that all women and girls who have undergone fistula treatment, including the forgotten women and girls whose conditions are deemed incurable or inoperable, are provided with and have access to comprehensive health-care services, holistic social integration services and careful follow-up, including counselling, education, family planning, socioeconomic empowerment, social protection and psychosocial services, for as long as needed, through, inter alia, skills development, family and community support and income-generating activities, so that they can overcome abandonment, stigma, ostracism and economic and social exclusion, and developing linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal; (k) Empowering fistula survivors to make informed decisions about their lives and to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival, and supporting the exercise of their voice, agency and leadership; (l) Accelerating efforts to improve the health of women and girls globally, with an increased focus on social determinants that affect their well -being and that include the provision of universal access to quality education for women and girls, economic empowerment, with access to microcredit, savings and microfinancing, legal reforms, the promotion and support of their meaningful participation in decision-making at all levels, social initiatives, including legal literacy to protect women and girls from violence and discrimination, child, early and forced marriage and early pregnancy; (m) Educating individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevented and treated, and increasing awareness of the needs of pregnant women and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of mental and physical health, including sexual and reproductive health, by working with community and religious leaders, traditional birth attendants and midwives, women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers; (n) Enhancing the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and further strengthening their involvement as partners, including in the global Campaign to End Fistula; A/C.3/73/L.20/Rev.1 18-19369 8/8 (o) Strengthening awareness-raising and advocacy, including through the media, to effectively reach families and communities with key messages on fistula prevention and treatment and social reintegration; (p) Strengthening research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes and ending fistula within a decade; (q) Strengthening research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near- miss cases as part of a national maternal death surveillance and response system, integrated within national health information systems; (r) Improving data collection, pre- and post-surgery, to measure progress in addressing needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health-related complications, so as to address the challenges of improving maternal health; (s) Providing essential health-care services, equipment and supplies, education, skills training and income-generating projects and support to women and girls so that they can break out of the cycle of poverty; 15.

A/C.3/71/L.16/Rev.1 16-20397 2/8 post-2015 development agenda, entitled “Transforming our world: the 2030 Agenda for Sustainable Development”, 7 Reaffirming also the Universal Declaration of Human Rights, 8 the Convention on the Elimination of All Forms of Discrimination against Women 9 and the Convention on the Rights of the Child, 10 recalling the International Covenant on Economic, Social and Cultural Rights, 11 and urging States that have not done so to consider, as a matter of priority, signing, ratifying or acceding to those Conventions and the Optional Protocols thereto, 12 Taking note of the report of the Secretary-General 13 and the conclusions and recommendations contained therein, Stressing the interlinkages between poverty, malnutrition, lack of or inadequate or inaccessible health-care services, early childbearing, child, early and forced marriage, violence against young women and girls and gender inequality as root causes of obstetric fistula, and that poverty remains the main social risk factor, Recognizing that the difficult socioeconomic conditions that exist in many developing countries, in particular the least developed countries, have resulted in the acceleration of the feminization of poverty, Recognizing also that early childbearing increases the risk of complications during pregnancy and delivery and entails a much higher risk of maternal mortality and morbidity, and deeply concerned that early childbearing and limited access to the highest attainable standard of mental and physical health, including sexual and reproductive health, specifically timely access to high -quality emergency obstetric care, cause high levels of obstetric fistula and other maternal morbidities, as well as maternal mortality, Recognizing further that adolescent girls are at particular risk of maternal death and morbidity, including obstetric fistula, and concerned that the leading cause of death among girls aged 15 to 19 in many low- and middle-income countries is complications from pregnancy and childbirth and that women aged 30 and older are at increased risk of developing complications and of dying during childbirth, Recognizing that lack of access to sexual and reproductive health, especially emergency obstetric services, remains among the leading causes of obstetric fistula, leading to ill health and death for women and girls of childbearing age in many regions of the world, and that a dramatic and sustainable scaling -up of quality treatment and health-care services, including high quality emergency obstetric services and also of the number of trained, competent fistula surgeons and midwives, is needed to significantly reduce maternal and newborn mortality and to eradicate obstetric fistula, __________________ 7 Resolution 70/1. 8 Resolution 217 A (III). 9 United Nations, Treaty Series, vol. 1249, No. 20378. 10 Ibid., vol. 1577, No. 27531. 11 See resolution 2200 A (XXI), annex. 12 United Nations, Treaty Series, vol. 2131, No. 20378; and vols. 2171 and 2173, No. 27531; and resolution 66/138, annex. 13 A/71/306. (...) Stresses the need to address the social issues that contribute to the problem of obstetric fistula, such as poverty, lack of or inadequate education for women and girls, lack of access to health-care services, including sexual and reproductive health-care services, early childbearing, child, early and forced marriage and the low status of women and girls; 4. (...) Calls upon States and/or the relevant funds and programmes, organs and the specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector, to end obstetric fistula within a generation by: A/C.3/71/L.16/Rev.1 16-20397 6/8 (a) Redoubling their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high -quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care; (b) Making greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health -care services and ensure that women and girls have access to the full continuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery; (c) Supporting the training of doctors and surgeons, nurses and other health - care workers in lifesaving obstetric care, especially midwives, who are the front -line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, including training on fistula prevention, treatment and care as a standard element of the training curricula of health professionals; (d) Ensuring universal access through national policies, plans and programmes that make maternal and newborn health -care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible, including in rural and remote areas and among the poorest women and girls, through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula; (e) Developing, implementing and supporting national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula within a generation, developing further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, which is preventable, including by ensuring access to affordable, accessible, comprehensive, high-quality maternal health-care services, and, within countries, incorporating into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor, vulnerable women and girls; (f) Establishing or strengthening, as appropriate, a national task force for obstetric fistula, led by the Ministry of Health, to enhance national coordination and improve partner collaboration to end obstetric fistula; (g) Strengthening the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obstetric fistula and to treat existing cases by increasing national budgets for health, ensuring that A/C.3/71/L.16/Rev.1 7/8 16-20397 adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of trained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled “Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development”, which provides background information and principles for developing fistula prevention and treatment programmes, as appropriate; (h) Mobilizing funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well-being and survival and to prevent the recurrence of subsequent fistulas by making post -surgery follow- up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies; (i) Ensuring that all women and girls who have undergone fistula treatment, including the forgotten women and girls whose conditions are deemed incurable or inoperable, are provided with and have access to comprehensive health -care services, holistic social integration services and careful follow-up, including counselling, education, family planning and socioeconomic empowerment, for as long as needed, through, inter alia, skills development and income -generating activities, so that they can overcome abandonment and social exclusion, and developing linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal; (j) Empowering fistula survivors to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival; (k) Educating individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevented and treated, and increasing awareness of the needs of pregnant wo men and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of mental and physical health, including sexual and reproductive health, by working with community and religious leaders , traditional birth attendants and midwives, including women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers; (l) Enhancing the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and further strengthening their involvement as partners, including in the global Campaign to End Fistula; A/C.3/71/L.16/Rev.1 16-20397 8/8 (m) Strengthening awareness-raising and advocacy, including through the media, to effectively reach families and communities with key messages on fistula prevention and treatment and social reintegration; (n) Strengthening research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes and ending fistula within a generation; (o) Strengthening research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near-miss cases as part of a national maternal death surveillance and response system, integrated within national health information systems; (p) Improving data collection, pre- and post-surgery, to measure progress in addressing the needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health -related complications, so as to address the challenges of improving maternal health; (q) Providing essential health-care services, equipment and supplies, education, skills training and income-generating projects and support to women and girls so that they can break out of the cycle of poverty; 15.

A/RES/71/169 Intensification of efforts to end obstetric fistula 2/8 Convention on the Rights of the Child, 10 recalling the International Covenant on Economic, Social and Cultural Rights, 11 and urging States that have not done so to consider, as a matter of priority, signing, ratifying or acceding to those conventions and the optional protocols thereto, 12 Taking note of the report of the Secretary-General 13 and the conclusions and recommendations contained therein, Stressing the interlinkages between poverty, malnutrition, lack of or inadequate or inaccessible health-care services, early childbearing, child, early and forced marriage, violence against young women and girls and gender inequality as root causes of obstetric fistula, and that poverty remains the main social risk factor, Recognizing that the difficult socioeconomic conditions that exist in many developing countries, in particular the least developed countries, have resulted in the acceleration of the feminization of poverty, Recognizing also that early childbearing increases the risk of complications during pregnancy and delivery and entails a much higher risk of maternal mortality and morbidity, and deeply concerned that early childbearing and limited access to the highest attainable standard of mental and physical health, including sexual and reproductive health, specifically timely access to high -quality emergency obstetric care, cause high levels of obstetric fistula and other maternal morbidities, as well as maternal mortality, Recognizing further that adolescent girls are at particular risk of maternal death and morbidity, including obstetric fistula, and concerned that the leading cause of death among girls aged 15 to 19 in many low- and middle-income countries is complications from pregnancy and childbirth and that women aged 30 and older are at increased risk of developing complications and of dying during childbirth, Recognizing that lack of access to sexual and reproductive health, especially emergency obstetric services, remains among the leading causes of obstetric fistula, leading to ill health and death for women and girls of childbearing age in many regions of the world, and that a dramatic and sustainable scaling -up of quality treatment and health-care services, including high quality emergency obstetric services, and of the number of trained, competent fistula surgeons and midwives, is needed to significantly reduce maternal and newborn mortality and to eradicate obstetric fistula, Noting that a human rights-based approach to eliminating obstetric fistula and efforts to eliminate obstetric fistula should be underpinned by the principles of, inter alia, accountability, participation, transparency, empowerment, sustainability, non-discrimination and international cooperation, Deeply concerned about discrimination against women and girls and the violation and abuse of their human rights, which often result in reduced access to education and nutrition, compromising their physical and mental health and well- being and their enjoyment of the rights, opportunities and benefits of childhood and adolescence compared with boys, and often in their being subjected to various forms _______________ 10 Ibid., vol. 1577, No. 27531. 11 See resolution 2200 A (XXI), annex. 12 United Nations, Treaty Series, vol. 2131, No. 20378; ibid., vols. 2171 and 2173, No. 27531; resolution 66/138, annex, and resolution 63/117, annex. 13 A/71/306. (...) Stresses the need to address the social issues that contribute to the problem of obstetric fistula, such as poverty, lack of or inadequate education for women and girls, lack of access to health-care services, including sexual and reproductive health-care services, early childbearing, child, early and forced marriage and the low status of women and girls; 4. (...) Calls upon States and/or the relevant funds and programmes, organs and the specialized agencies of the United Nations system, within their respective mandates, and invites the international financial institutions and all relevant actors of civil society, including non-governmental organizations, and the private sector, to end obstetric fistula within a generation by: (a) Redoubling their efforts to meet the internationally agreed goal of improving maternal health by making maternal health-care services and obstetric fistula treatment geographically and financially accessible, including by ensuring universal access to skilled attendance at birth and timely access to high -quality emergency obstetric care and family planning, as well as appropriate prenatal and postnatal care; (b) Making greater investments in strengthening health systems, ensuring adequately trained and skilled human resources, especially midwives, obstetricians, gynaecologists and doctors, and providing support for the development and maintenance of infrastructure, as well as investments in referral mechanisms, equipment and supply chains, to improve maternal and newborn health -care services and ensure that women and girls have access to the full continuum of care, with functional quality control and monitoring mechanisms in place for all areas of service delivery; (c) Supporting the training of doctors and surgeons, nurses and other health - care workers in lifesaving obstetric care, especially midwives, who are the front-line workers in the fight to prevent obstetric fistula and maternal and newborn mortality, A/RES/71/169 Intensification of efforts to end obstetric fistula 6/8 including training on fistula prevention, treatment and care as a standard element of the training curricula of health professionals; (d) Ensuring universal access through national policies, plans and programmes that make maternal and newborn health -care services, particularly family planning, skilled attendance at birth, emergency obstetric and newborn care and obstetric fistula treatment, financially accessible, including in rural and remote areas and among the poorest women and girls, through, where appropriate, the establishment and distribution of health-care facilities and trained medical personnel, collaboration with the transport sector for affordable transport options, the promotion of and support for community-based solutions and the provision of incentives and other means to secure the presence in rural and remote areas of qualified health-care professionals who are able to perform interventions to prevent obstetric fistula; (e) Developing, implementing and supporting national and international prevention, care and treatment and socioeconomic reintegration and support strategies, policies and plans to eliminate obstetric fistula within a generation, developing further multisectoral, multidisciplinary, comprehensive and integrated action plans in order to bring about lasting solutions and put an end to maternal mortality and morbidity and obstetric fistula, which is preventable, including by ensuring access to affordable, accessible, comprehensive, high -quality maternal health-care services, and, within countries, incorporating into all sectors of national budgets policy and programmatic approaches to address inequities and reach poor, vulnerable women and girls; (f) Establishing or strengthening, as appropriate, a national task force for obstetric fistula, led by the Ministry of Health, to enhance national coordination and improve partner collaboration to end obstetric fistula; (g) Strengthening the capacity of health-care systems, in particular public health systems, to provide the essential services needed to prevent obstetric fistula and to treat existing cases by increasing national budgets for health, ensuring that adequate funds are allocated to reproductive health, including for obstetric fistula, ensuring access to fistula treatment through increased availability of trained, expert fistula surgeons and permanent, holistic fistula services integrated into strategically selected hospitals, thereby addressing the significant backlog of women and girls awaiting surgical repair of fistula, and encouraging communication among fistula centres to facilitate training, research, advocacy and fundraising and the application of relevant medical standards, including consideration of the use of the World Health Organization manual entitled “Obstetric Fistula: Guiding Principles for Clinical Management and Programme Development”, which provides background information and principles for developing fistula prevention and treatment programmes, as appropriate; (h) Mobilizing funding to provide free or adequately subsidized maternal health-care and obstetric fistula repair and treatment services, including by encouraging networking among providers and the sharing of new treatment techniques and protocols to protect women’s and children’s well -being and survival and to prevent the recurrence of subsequent fistulas by making post -surgery follow- up and the tracking of fistula patients a routine and key component of all fistula programmes, and also to ensure access to elective caesarean sections for fistula survivors who become pregnant again in order to prevent fistula recurrence and to increase the chances of survival of mother and baby in all subsequent pregnancies; Intensification of efforts to end obstetric fistula A/RES/71/169 7/8 (i) Ensuring that all women and girls who have undergone fistula treatment, including the forgotten women and girls whose conditions are deemed incurable or inoperable, are provided with and have access to comprehensive health -care services, holistic social integration services and careful follow -up, including counselling, education, family planning and socioeconomic empowerment, for as long as needed, through, inter alia, skills development and income -generating activities, so that they can overcome abandonment and social exclusion, and developing linkages with civil society organizations and women’s and girls’ empowerment programmes so as to help to achieve this goal; (j) Empowering fistula survivors to contribute to community sensitization and mobilization as advocates for fistula elimination, safe motherhood and newborn survival; (k) Educating individual women and men, girls and boys, communities, policymakers and health professionals about how obstetric fistula can be prevente d and treated, and increasing awareness of the needs of pregnant women and girls, as well as of those who have undergone surgical fistula repair, including their right to the highest attainable standard of mental and physical health, including sexual and reproductive health, by working with community and religious leaders, traditional birth attendants and midwives, women and girls who have suffered from fistula, the media, social workers, civil society, women’s organizations, influential public figures and policymakers; (l) Enhancing the participation of men and adolescent boys in the intensification of efforts to end obstetric fistula and further strengthening their involvement as partners, including in the global Campaign to End Fistula; (m) Strengthening awareness-raising and advocacy, including through the media, to effectively reach families and communities with key messages on fistula prevention and treatment and social reintegration; (n) Strengthening research, monitoring and evaluation systems, including by developing a community- and facility-based mechanism for the systematic notification of obstetric fistula cases and maternal and newborn deaths to ministries of health, and their recording in a national register, and by acknowledging obstetric fistula as a nationally notifiable condition, triggering immediate reporting, tracking and follow-up for the purpose of guiding the development and implementation of maternal health programmes and ending fistula within a generation; (o) Strengthening research, data collection, monitoring and evaluation to guide the planning and implementation of maternal health programmes, including for obstetric fistula, by conducting up-to-date needs assessments on emergency obstetric and newborn care and for fistula and routine reviews of maternal deaths and near-miss cases as part of a national maternal death surveillance and response system, integrated within national health information systems; (p) Improving data collection, pre- and post-surgery, to measure progress in addressing needs for surgical treatment and the quality of surgery, rehabilitation and socioeconomic reintegration services, including post-surgery prospects for successful subsequent pregnancies, live births and severe health-related complications, so as to address the challenges of improving maternal health; (q) Providing essential health-care services, equipment and supplies, education, skills training and income-generating projects and support to women and girls so that they can break out of the cycle of poverty; A/RES/71/169 Intensification of efforts to end obstetric fistula 8/8 15.