Completely Preventable, Obstetric Fistulas Devastate Communities Because of Lack of Funding

Liz Boucher


Liz and her two daughters

Liz Boucher became involved with #Fight4HER as a 2020 Summer of HER fellow. She lives with her husband and two daughters in New Hampshire.

Observed for the first time in 2013, the International Day to End Obstetric Fistula on May 23rd highlights the struggle of millions of women and girls who live with or who have died from an obstetric fistula. Entirely preventable, obstetric fistulas are holes that develop between the birth canal and the bladder or rectum from prolonged and obstructed labor without timely access to reproductive healthcare like a cesarean section. Even more devastating, prolonged and obstructed labor results in stillbirths for more than 90 percent of cases. If left untreated, fistulas can lead to urinary and fecal incontinence, infections, depression, social isolation, and even death. The United Nations Population Fund (UNFPA) reports that some 800 women and girls around the world die every day as a result of pregnancy and child-birth related complications. For every one woman who dies as a result of pregnancy, UNFPA estimates 20 women experience a maternal morbidity such as obstetric fistula

Abou Aminu is a Nigerian woman who developed a fistula after three days of labor and the stillbirth of her child. She was unable to receive a needed cesarean section for the delivery. Following the birth, Abou was rejected by her family and eventually her husband because she was unable to control her urine. Further complications prevented Abou from being able to care for herself. She would have been abandoned if it were not for a Doctors Without Borders Fistula Center. Abou was connected to a center where a fistula surgery was successful. She was provided with physical and psychological therapy to rehabilitate her back to independence and family acceptance. If I were a woman in rural Nigeria, my own labor may have left me with a fistula. Fortunately, I was able to receive a cesarean section after 22 hours of labor including four hours of pushing during childbirth for a baby that was ultimately never going to be delivered vaginally. 

In 2012, 167 countries co-sponsored a United Nations resolution that called on all Member States to support UNFPA and its now 92 partner organizations in the Campaign to End Fistula. This resolution calls for technical and financial support to countries most burdened by obstetric fistulas in order to achieve the United Nations’ 3rd Sustainable Development Goal which includes new targets for reducing maternal mortality. These indicators include an increase in the proportions of births attended to by a skilled health professional and access to universal sexual and reproductive healthcare services all of which will work to eliminate obstetric fistula.

Though UNFPA remains the leader in the global Campaign to End Fistula, the UN reproductive health and family planning agency lost all U.S. aid in 2017when disgraced former President Trump took office. Fortunately, President Biden restored funding to UNFPA in January. 

According to UNFPA, U.S. funding helped the agency perform 1,251 fistula surgeries and prevent 947,000 unplanned pregnancies, 295,000 unsafe abortions, and 2,340 maternal deaths in 2016 alone. Women in over 150 countries rely on UNFPA funding, and those countries make up approximately 80% of the world’s population. The loss of U.S. funding from UNFPA meant millions of people, particularly women and girls of color in developing and conflict-torn countries, lost access to contraception, as well as services that save them from obstetric fistula, HIV/AIDS, and maternal mortality. According to the Campaign to End Fistula, the average cost of comprehensive fistula treatment including surgery, post-operative care, and rehabilitation services is $600. A cesarean birth to prevent fistula costs even less. The cost to restore dignity and hope for the woman is priceless. 

Over the past four years, essential life-saving measures have been severely restricted or eliminated by the loss of the U.S. share of international funding for reproductive services. With funding fragmented between each administration, women and families are left with unstable reproductive health services. U.S. funds should not be used as a weapon against women and families; this weapon is leaving holes in the foundation of countries’ economic and political development. 

Lack of U.S. support for reproductive healthcare is a misogynistic approach to international relationships, no better than the oppression of women and human-rights attacks in conflict-torn countries. President Biden has restored U.S. funding to UNFPA. Let’s not let funding be lost again. It is time for the US to pay their fair share in UNFPA funding. That’s why Population Connection Action Fund is requesting that the US invest $116 million in UNFPA for fiscal year 2022.

The International Day to End Obstetric Fistula is more than just raising awareness of a health complication more prevalent in the developing world. May 23rd highlights reproductive healthcare as life-saving, essential care that ensures every pregnancy and childbirth is safe and that every child’s potential is fulfilled. The good news is that fistulas are preventable and correctable with access to reproductive healthcare and supplies, family planning, skilled birth attendants, and emergency obstetric care when complications arise.

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