Obstetric fistula is an abnormal opening between the reproductive tract of a woman (usually the vagina and urinary tract and frequently the bladder) and rectum or both that develops after several hours of prolonged or obstructed labour. This is mostly due to delay in receiving appropriate care. This policy brief provides an analysis of the current prevalence of obstetric fistula in Malawi noting that incidents have been on the increase. It proposes long-term prevention measures which include ensuring universal access to emergency obstetric care, improving access to family planning services, increased education for girls and women, economic empowerment of communities, and promoting gender equality. It calls for a collaborative multi-sectoral approach in addressing causes and predisposing factors is key to prevention of obstetric fistula.