Three members of the United States House of Representatives have recently brought attention to a debilitating injury known as obstetric fistula, from which, according to the World Health Organization, at least two million women and girls worldwide currently suffer.1 Representatives Carolyn B. Maloney (D-NY), Christopher H. Smith (R-NJ), and Joseph Crowley (D-NY) introduced separate measures to provide U.S. funding for the prevention, treatment, and repair of obstetric fistula throughout the developing world.
Obstetric fistula is an injury of childbirth that occurs when a woman endures obstructed labor, often for several days, without receiving appropriate medical attention.2 This condition, affecting mainly young women ages 15-19, arises when the infant's head presses against the woman's vagina and surrounding tissues. This pressure causes a hole to develop either between the vagina and the bladder or the vagina and the rectum which results in loss of control of the bladder or rectum as well as nerve damage to the woman's legs. In most cases, this condition also leads to the death of the infant.3
Women afflicted with obstetric fistula suffer from both acute and long term consequences of their condition. Aside from the immediate loss of their infants, bladder or rectal control, and the ability to become pregnant, afflicted women are often rejected by their husbands and/or communities. Due to their "unclean" state, afflicted women's parents often refuse to allow them to return home, assist them in seeking medical care, or provide them with emotional support.4 Women suffering from obstetric fistula frequently become social outcasts, unable to generate income and thus provide for their own most basic needs.5
Obstetric fistula, however, is preventable and treatable, as is evidenced by its near total eradication in the industrialized world. Preventative measures include prenatal care and screening, the presence of skilled birth attendants at delivery, prompt treatment for complications, access to Caesarean sections, and quality postnatal care. Programs aimed at addressing this condition are expanding, both in variety of services provided and in number of women assisted, and governmental and private funding for these projects is on the rise.6 Nonetheless, there is more to do.
Representative Maloney, along with several other legislators, introduced the Repairing Young Women's Lives Around the World Act, a bill aimed at funding obstetric fistula services.7 This legislation would direct a $34 million contribution to the United Nations Population Fund (UNFPA) strictly for fistula related services. The Act is the legislators' attempt at a compromise with President Bush, who de-funded UNFPA in 2002 under allegations that the organization supported forced abortion and sterilization.8 The legislators remind us that the President's own delegation determined the reports to be unfounded. The bill requests appropriations "to the United Nations Population Fund (UNFPA) only for prevention and repair of obstetric fistula."9
As a separate measure, Representative Smith has offered an amendment to the Foreign Relations Authorization Act, Fiscal Years 2006 and 200710, which would authorize $5 million each year for the treatment of obstetric fistula in developing countries. This amendment calls for the establishment and operation of treatment centers where doctors can perform obstetric fistula surgery and staff can offer post-surgery care and support for patients, including food, shelter, and transportation. This amendment also includes provisions for activities aimed at reducing the incidence of obstetric fistula, including seminars and educational materials, and prioritizes services for women suffering from obstetric fistula as a result of sexual abuse associated with conflict or officially sanctioned abuse.11
Representative Crowley, in an effort to expand Representative Smith's amendment to include prevention along with treatment, has offered his own amendment. While Smith's amendment implies the funding of contraceptives, Crowley's explicitly states an intention to "expand access to contraception services for the prevention of pregnancies among women whose age or health status place them at high risk of prolonged or obstructed childbirth."12
Representative Bobby Rush (D-IL), a proponent of the Repairing Young Women's Lives Around the World Act, said that "eradication of [obstetric fistula] in developing countries is a goal that the U.S. should work to make a reality."13 Representative Maloney explained, "the United States could and should lead the world in fighting [obstetric fistula], but right now we are doing next to nothing. This bill will compassionately help women around the world who are badly in need."14
- Carolyn B. Maloney, Joseph Crowley, and Bobby L. Rush, "Repairing Young Women's Lives Around the World," Letter to congressional colleagues dated 27 May 2005.
- Ending the Silent Suffering (PLACE: The Campaign to End Fistula, 2005).
- Bobby L. Rush, "Repairing Young Women's Lives Around the World," Statement released on 8 June 2005.
- Quality/Calidad/Qualité No. 16 (New York: The Population Council, 2004).
- Rush, "Repairing Young Women's Lives."
- Maloney, Crowley, and Rush, "Repairing Young Women's Lives."
- Congresswoman Carolyn B. Maloney, "Congressional Legislation Seeks an End to Obstetric Fistula Around the World," Press Release published on 9 July 2005.
- Repairing Young Women's Lives Around the World Act, H.R. 2811, 109th Cong. (2005).
- Foreign Relations Authorization Act, Fiscal Years 2006 and 2007, H.R. 2601, 109th Cong. (2005).
- To amend the Foreign Assistance Act of 1961 to provide for the establishment of centers for the treatment of obstetric fistula in developing countries, H.R. 2957, 109th Cong. (2005).
- Amendment to H.R. 2601, offered by Mr. Crowley of New York, 109th Cong. (2005).
- Rush, "Repairing Young Women's Lives."
- Maloney, "Congressional Legislation Seeks an End."