Chronic Maternal Pelvic Morbidity: A Neglected Tragedy: Where is Pelvic Maternal Morbidity in Maternal and Child Health?  : Advocating for a Public Health Approach to Pelvic Floor Disorders Resulting from Pregnancy and Childbirth Trauma.

Pelvic floor disorders (PFDs) - which include pelvic organ prolapse, urinary incontinence, perineal trauma, fecal incontinence, and sexual dysfunction - affect one in four women globally. There is compelling epidemiological and pathophysiological evidence that these conditions result from childbirth trauma. Yet chronic maternal pelvic morbidity remains a neglected issue within the maternal health agenda worldwide. Current health systems limit public health approaches to maternal health to just 6 weeks after birth, overlooking the long-term pelvic floor consequences of childbirth trauma. In many countries, women suffering from PFDs often face stigma, cultural isolation, and economic hardship yet have little access to care owing to cultural taboos, policy-based neglect, systemic under-reporting and underinvestment, and limited preventive and cost-effective care frameworks within the public health system. This white paper advocates for the extension of the paradigm of maternal health beyond 6 weeks postpartum to encompass all the repercussions of childbirth pelvic floor trauma, irrespective of the timeframe of their development. It concludes with a call to action urging multilateral agencies, national health ministries, policymakers, urogynecologists, public health professionals, and the social sector to join forces in a coordinated multisectoral response. Addressing chronic maternal pelvic morbidity requires the inclusion of pelvic health services within existing maternal and reproductive health programs, the development of global public health guidelines that prioritize prevention and timely management, and the training of health care providers at all levels of the health system. This white paper asks for sustained policy support, greater investment in research and the development of cost-effective therapies, stronger advocacy, and integration with existing programs such as fistula care.