Physician Education for Fistula Treatment Act

Obstetric fistula, an abnormal opening between a woman’s genital tract and her urinary tract or rectum, is a devastating childbirth injury caused by prolonged, obstructed labor in the absence of timely and quality medical care.

Worldwide, an estimated 500,000 women and girls live with obstetric fistula with thousands more occurring annually. It occurs disproportionately among impoverished, vulnerable, and marginalized girls and women.

Women who experience an obstetric fistula suffer life-shattering consequences including chronic incontinence, shame, social isolation, poverty, and physical, mental, and emotional health problems.

Obstetric fistula is a violation of human rights and an indicator of the failure of health systems to deliver universally accessible, timely, and quality health care to women and girls who need it.

Obstetric fistula is preventable. Universal health coverage and universal access to quality care are essential in ending preventable maternal and newborn deaths and disabilities, including fistula. Skilled health personnel at birth, emergency obstetric and newborn care, and universal access to modern contraception are the most effective interventions to prevent maternal mortality and fistula.

Safeguarding the rights and dignity of women and girls and addressing underlying gender and socioeconomic inequalities and discrimination which drive obstetric fistula are equally important to end the condition.

In 2018 and 2020, the United Nations General Assembly resolutions on fistula were adopted, calling for “Ending fistula within a decade”. This represents a turning point in the global fight to eliminate fistula, as it brings the global objective and timeline for ending fistula into alignment with achieving the Sustainable Development Goals (SDGs)/Agenda 2030. The resolutions also call for an increased focus on social determinants to tackle the root causes of fistula.

Obstetric fistula can be surgically treated. The impact of an obstetric fistula-repair surgery is immediate and women can be reintegrated into society. There is however a high unmet need for treatment and social reintegration of fistula survivors.

In 90 percent of cases where women develop fistula and timely medical care is not available, a stillborn baby is tragically delivered.

The United Nations Population Fund (UNFPA)-led global Campaign to End Fistula, is a key contributor to promoting the rights, dignity, and well-being of women and girls. The Campaign focuses on prevention, treatment, social reintegration, and advocacy. Aimed at “leaving no one behind” and “reaching the furthest behind”, it contributes to achieving the SDGs and has also helped restore overall health, dignity, hope, and a sense of self-worth and agency to some of the poorest, most marginalized women and girls worldwide through its holistic, gender-sensitive, and rights-based approach to policies and programs for the elimination of obstetric fistula and several other maternal morbidities.

UNFPA has supported over 150,000 surgical repairs over the last two decades. The Campaign to End Fistula and its partners have made remarkable progress, but the needs remain great.

With 4 years to reach the global goal of ending fistula by 2030, significantly intensified investment, efforts, and partnerships at the international and national levels are required.

The International Day to End Obstetric Fistula which takes place on May 23, 2024, will be commemorated this year with the theme: “Her health, her right: Shaping a future without fistula”, emphasizing that every girl and woman has the fundamental right to health, including reproductive and sexual health, and that the continued existence of obstetric fistula is a “clear violation” of this right.

Purpose— The purpose of assistance under this section is to train and retain obstetrician-gynecologists (OB–GYNs) and sub-specialists in urogynecology and to help improve the quality of care to meet the health care needs of women in least developed countries.

Activities supported— Activities that may be supported by assistance under subsection (b) include the following:

In general— The President, acting through the Director of the John E. Fogarty International Center for Advanced Study in the Health Sciences, shall establish a comprehensive, integrated, 10-year strategy to address the shortage of physicians in least developed countries.

Elements— Such strategy shall maintain sufficient flexibility and remain responsive to the needs of women afflicted with childbirth-related injuries and shall include the following:

Report— Not later than 2 years after the date of the enactment of this Act, the President shall submit to Congress a report that contains the strategy required under this section.

In general— The President, acting through the Director of the John E. Fogarty International Center for Advanced Study in the Health Sciences, shall submit to Congress, on an annual basis, a report on the implementation of this Act for the preceding year.

Matters To be included— The report required under subsection (a) shall include an evaluation of the effectiveness and performance of the International OB/GYN and Urogynecology Promotion Program established under section 3 and all related community outreach and medical programs.

Childbirth-related injuries— The term “childbirth-related injuries” means injuries associated with obstructed labor, including—

Low-income country— The term “low-income country” means a country with a per capita gross national income of $1,035 or less.

Least developed country— The term “least developed country” means a country that—

Relevant executive branch agencies— The term “relevant executive branch agencies” means the Department of State, the United States Agency for International Development, and any other department or agency of the United States that participates in international health and humanitarian activities pursuant to the authorities of such department or agency or the Foreign Assistance Act of 1961.