How $300 Can Save Women’s Lives

by Peggy McGuinness

The Root over at Slate ran this piece on Monday about fistula and its devastating impact on the lives and health of women in the developing world:

How can it be, in this day and age, that 500,000 women a year die in childbirth? But it’s true. The World Health Organization estimates that 1,600 women die every day from complications in pregnancy and childbirth, bringing the annual total to over 580,000. And that doesn’t include millions more women who face serious complications from childbirth that have devastating effects on their lives. Among the most serious life-threatening conditions related to childbirth is fistula, a vaginal rupture caused by prolonged, obstructed labor.

Prevention and treatment of fistula sounds like a “no brainer” to those of is in the developed world, where the necessary preventative prenatal and obstetric health care has been widely available for almost a century. (Check out this Nick Kristoff column from 2003, noting that the site of the Waldorf-Astoria — where the US delegation camps out during the UN General Assembly every year — once housed the world’s first fistula hospital.) But, like so many other women’s health issues, it is tied up in cultural, religious, and tribal practices, and also connected to social control over women’s reproductive choices and sexual violence. Young victims of rape experiencing their first pregnancy are likely victims of this life-threatening complication. Most horrifying, however, is the contribution of malnutrition, which will no doubt spread with the current food crisis:

The root causes of fistula are grinding poverty and the low status of women and girls. In Ethiopia, the poverty and malnutrition in children contributes to the condition of stunting, where the girl skeleton, and therefore pelvis as well, do not fully mature. This stunted condition can contribute to obstructed labor, and therefore fistula.

So, what is the US government doing to help? In 2002, the Bush administration cut previously approved funding to the UN Population Fund (in protest to abortions in China), the one UN agency addressing reproductive care, and in particular fistula prevention and treatment. So, the current UNPF funding map looks like this (the grey areas are the non-contributing states):


But in February this year, the USG announced:

a new $70 million, five-year program – “Fistula Care” – to prevent and treat obstetric fistula in developing countries. The program will increase access to emergency obstetrical care; help hospitals strengthen their capacity to provide surgical fistula repair; and work with community groups and individuals to increase understanding about obstetric fistula and its prevention. “Fistula Care” will also conduct research to strengthen the quality of fistula services, and will work toward institutionalizing fistula prevention, repair, and reintegration programs in developing countries.

I don’t know how this USAID program is organized or where the money is directed (and readers with information are welcome to comment or contact me), but it strikes me as another example of duplicative, wasteful efforts that are made necessary only because certain elements of the government are uncomfortable with funding internationally the kind of broad reproductive health care (including abortions, where necessary) that is taken for granted in the U.S. While we wait until next January for a new, more sensible, policy on funding reproductive health care as part of the US contribution to the UN, we can privately help those who are already working to treat the condition in the countries most affected.

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