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Population prevalence helps leaders to develop appropriate health strategies and approaches. Yet it can be challenging to estimate the burden of rare diseases and conditions, particularly in contexts with low healthcare utilisation and patchy health data. The maternal morbidity of obstetric fistula exemplifies the challenges. Women with obstetric fistula develop urinary incontinence after giving birth, leading to stigma and shame.1 2 While obstetric fistula has been eliminated in much of the world, it persists in rural, low-resource settings where women do not have sufficient access to quality emergency obstetric care. Women who suffer from fistula-related incontinence may not be willing to disclose their problem.3 Medical records are a poor data source, since the population of women affected by obstetric fistula has limited access to medical care.4 Women with fistula may be better reached through community-based surveys, but surveyed women over-report urinary incontinence symptoms after birth, potentially inflating the perceived population burden of obstetric fistula.5