Obstetric Fistula Prevention, Treatment, Hope, and Dignity Restoration Act of 2022

Every two minutes, one woman dies from pregnancy-related complications. This means approximately 830 women die from pregnancy- or childbirth-related complications around the world every day. Of these deaths, 99 percent occur in developing countries. Over half of these deaths are in sub-Saharan Africa and one-third are in South Asia.

Obstetric fistula is one of the most severe and tragic pregnancy-related injuries, which occurs when a woman experiences prolonged, obstructed labor in the absence of trained medical assistance, which is most commonly a Caesarean section, necessary for a safe delivery.

Obstetric fistula is a hole that is formed between the bladder and the vagina, or the rectum and the vagina (or both). In the struggle to pass through the birth canal, the fetus puts constant pressure, sometimes for several days, on the bladder and vaginal or rectal walls, destroying the tissue that then dies and sloughs off, resulting in the abnormal opening or hole.

In approximately 90 percent of obstetric fistula cases, the baby will be stillborn. A mother will experience physical pain and multiple physical disabilities, as well as social and emotional trauma from living with incontinence and from the loss of her child.

In addition to constant uncontrollable leaking of urine, feces, or both, the physical con­se­quences of obstetric fistula may include frequent bladder infections, painful sores, kidney failure, infertility, foul odor, orthopedic injury, and nerve damage that makes normal walking impossible and internal genital scarring that destroys normal sexual function.

Women and girls with obstetric fistula are commonly ostracized by their families and communities, leading to depression, anxiety, post-traumatic stress disorder, social isolation and discrimination, suicidal thoughts or actions, and lack of adequate economic opportunities, resulting in deepening poverty, isolation, and vulnerability.

Although data on obstetric fistula is scarce, the United Nations Population Fund (UNFPA) and Johns Hopkins University estimates that an estimated 500,000 women and girls live with obstetric fistula with thousands more occurring annually.

Obstetric fistula was once common throughout the world, but over the last century has been virtually eliminated in Europe, North America, and other developed regions through improved access to high-quality, timely medical interventions, particularly emergency obstetric care including Caesarean sections.

Obstetric fistula is preventable through timely medical interventions and providing access to family planning for all women who need it. Social interventions such as alleviating poverty, delaying early marriage and early childbearing, educating and empowering young women, remedying gender and socioeconomic inequalities, and addressing malnutrition can also help prevent this complication.

The majority of obstetric fistula cases can be surgically treated. When performed by a skilled, competent surgeon, the procedure is relatively inexpensive with high rates of success.

In 2003, the UNFPA, EngenderHealth, and other partners launched a global Campaign to End Fistula (the Campaign) to identify and address obstetric fistula in an effort to develop a means to treat and support those women who are suffering and provide the necessary health services to prevent further cases. Operating in more than 55 countries across Africa, Asia, and the Arab region, the Campaign has four main goals: the prevention of fistula cases, treatment of existing fistula cases, social reintegration and follow up for fistula survivors, and advocacy for ending fistula.

In order to meet these goals, The Campaign supports and participates in the emerging “safe surgery” community of practice that strengthens surgical ecosystems in low- and middle-income countries (LMIC) towards better access to essential and life-saving surgeries, which includes improved training, equipment, supplies, infrastructure and health worker density for timely access to Caesarean sections and for environments that optimize outcomes of fistula surgery.

Since 2003, UNFPA has directly supported more than 85,000 fistula repairs, with additional repairs supported by Campaign partners.

The COVID–19 pandemic caused overloaded health systems and reallocation of human and financial resources with disruptions to services resulting in an undermining of the sexual and reproductive health and rights of women and girls. Beginning in 2020, Fistula repairs were widely halted or slowed down due to COVID–19, as they were deemed nonurgent and unsafe during the pandemic. This may result in an increased backlog of fistula cases.

The United States Agency for International Development (USAID), in accordance with the United States Government’s commitment to ending preventable maternal and newborn deaths and disabilities, currently supports fistula treatment services in seven countries. As part of a comprehensive approach, USAID addresses fistula prevention as well as reintegration support to women as they re-enter their community and family life after surgery. Cumulatively, USAID fistula support has trained thousands of medical personnel and volunteers, including 350 fistula surgeons. Since 2004, more than 56,200 women have received fistula repairs with USAID support.

The United States has committed to joining multilateral efforts involving the United Nations and others to make progress toward achieving the Sustainable Development Goals (SDGs), including through the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). Eliminating obstetric fistula is key to achieving the SDGs’ vision of “leaving no one behind.”.

In his July 2020 report prepared for the General Assembly called Intensifying efforts to end obstetric fistula within a decade, United Nations Secretary General Antonio Guterres underscored the urgency around action to end fistula in the wake of the COVID–19 pandemic, noting that “the pandemic caused by COVID–19 has disrupted health services and exacerbated gender-based, socioeconomic and intersectional inequalities. The health of women and girls, in particular those in fragile contexts, is adversely affected by the reallocation of resources and priorities. Essential health services including contraception and emergency obstetric care remain critical to prevent maternal mortality and fistula. Since fistula surgery is considered to be elective care and, therefore, suspended during the pandemic to protect the safety of patients, new strategies will be required in the post-COVID–19 recovery period to address the expected backlog of cases.”.

Authorization— The President is authorized, in accordance with this section and section 4, to provide assistance, including through international organizations, national governments, and international and local nongovernmental organizations, to—

Activities— Assistance provided pursuant to this section and section 4 shall focus on the following:

promote the UNFPA-led global Campaign to End Fistula and the International Obstetric Fistula Working Group; and

be used for the development and implementation of evidence-based programs, including monitoring, evaluation, and research to measure the effectiveness and efficiency of such programs throughout their planning and implementation phases.