Why the U.S. Should Address Obstetric Fistula and How

Pregnancy shouldn’t leave a woman with a disability and ostracized from her community.  And Congress should ensure investments for the more than two million women worldwide that have obstetric fistula.

Pregnancy shouldn’t leave a woman with a disability and ostracized from her community.  And Congress should ensure investments for the more than two million women worldwide that have obstetric fistula and that we do what we can to prevent new cases from occurring. Fistula results from prolonged labor without medical attention due to the pressure created internally from obstructed delivery, which kills tissue where a hole between the woman’s vagina and rectum develops, leaving her without control of her bladder and and/or bowels for the rest of her life without treatment.  It often results in the death of the infant.  Many women with obstetric fistula are abandoned by their husbands and families because they are considered “unclean” due to the leaking of urine and/or feces.  Left without support, the women are often forced to beg or turn to sex work to survive.

Fistula was once common throughout the world, but over the last century has been eradicated in Europe and North America through improved medical care. For example, New York’s hospital for fistula patients, now the site of the Waldorf Astoria Hotel, closed in 1895 because of diminishing cases.  But still in 2010, from Bangladesh to Botswana, women continue to face these challenging deliveries and the complications associated with them, including obstetric fistulas.

I met the inspiring Catherine Hamlin and invited her to brief my colleagues about her amazing work at the Addis Abba Fistula Hospital.  I was so moved to learn from her first hand about the unnecessary suffering of women in Ethiopia and how Dr. Hamlin’s life work has been devoted to their repair and treatment.  This only strengthened my resolve to address this issue – not only to treat these women but also prevent it happening to others.    I was so gratified to be recognized by the Washington, DC area Tesfa Ineste Committee of Ethiopian Americans, along with my colleague Rep. Chris Smith (R-NJ) for our efforts to raise awareness about obstetric fistula, as well as supporting life-saving efforts in developing countries.

Fortunately, multilateral organizations such as UNFPA, the United Nations Population Fund, and its partners in the Campaign to End Fistula, as well as bilateral organizations such as USAID are working with partners on a global campaign to prevent and treat fistula with the goal of making the condition as rare in sub-Saharan Africa and Asia as it is in the United States.

Being able to repair a fistula is life changing – and it will have a direct impact on a woman and her family if she is able to stay with her community, rather than to be shunned by them.  At this point, the global community can do just that for about $300 for each repair.  As essential as treatment is, strategic investments need to be made in prevention of obstetric fistula, which includes:  medical interventions such as skilled birth attendants during labor and childbirth, providing access to voluntary family planning, and emergency obstetric care for women who develop complications as well as social interventions such as delaying early marriage and educating and empowering young women.  These essential investments reap a number of positive benefits in the lives of women and their communities beyond preventing fistulas, creating a multiplier effect of benefits that are gained from making these particular investments in obstetric fistula prevention.

Surgical repair has enabled many women and girls to physically recover from an obstetric fistula, but an estimated 2 million more women and girls are currently struggling with the devastating impact of an obstetric fistula and tens of thousands of additional cases continue to occur each year.  The time has come to meet the needs, and stop the unnecessary creation of new fistulas.

Today we are introducing comprehensive legislation to both prevent new obstetric fistulas and treat existing ones.  The “Fistula Prevention, Treatment, Hope and Dignity Restoration Act” will bring new hope and opportunities to finally end this preventable condition.

The bill authorizes the President to provide assistance to prevent and treat fistula, including through increasing access to prenatal care, emergency obstetric care, postnatal care, and voluntary family planning; building local capacity and improving national health systems; addressing underlying social and economic inequities such as reducing the incidence of child marriage and increasing access to formal and informal education; and supporting reintegration and training programs to help women who have undergone treatment return to full and productive lives.

The legislation also supports coordination among donors, multilateral institutions, the private sector, nongovernmental and civil society organizations, and governments facilitated by the International Obstetric Fistula Working Group, and to support comprehensive prevention and treatment of obstetric fistula.  Support for monitoring, evaluation, and research to measure the effectiveness and efficiency of such programs throughout their planning and implementation phases will ensure the most efficient and effective use of US foreign assistance dollars.

Spread the word.  Help us get the United States to make a long-term impact with comprehensive and effective investments.  Women and girls around the world will know that the United States cares about their health and well-being – and that we can both talk the talk and walk the walk.