The Fight Against Fistulas

Despite funding troubles, organizations are rallying to save women from a dangerous, humiliating condition

| May / June 2004

Imagine this scenario: A pregnant woman labors for days and nights without medical care, knowing her child is likely to be stillborn. As a result of the painfully traumatic labor, part of the mother's vaginal tissue is pressed between her pelvic bone and the baby's head. The blood supply to the tissue is cut off and the tissue dies, leaving a hole, or fistula, between the vagina and either the bladder or the rectum. She becomes incontinent and is banished from her home.

The first fistula hospital opened in New York City in 1850, back when fistulas were common in the United States. By 1895 the hospital had closed its doors because basic medical care and improved technology had made the disorder practically unknown.

But fistulas are still prevalent in the developing world, in part because of female genital mutilation. Although accurate counts are hard to come by in the regions where the problem is common, the United Nations estimates that about 2 million women live with obstetric fistulas, causing lifelong incontinence and terrible health problems. And because of the severe social stigma surrounding the condition -- women with fistulas are considered 'dirty' because of constant urine and/or stool leakage -- their husbands typically abandon them and they have difficulty securing jobs.

Fortunately, fistulas are preventable, and when they occur they're treatable with a simple reconstructive operation that costs between $100 and $400. But most women suffering from fistulas don't have access to reconstructive surgery, or cannot afford it. Leading the fight to treat and end fistulas, Catherine Hamlin, M.D., co-founded the Addis Ababa Fistula Hospital ( in Ethiopia in 1974. Hamlin and her staff have treated more than 25,000 women.

'In Ethiopia alone, more than 8,500 women will suffer from new fistulas this year,' Hamlin told an audience in Los Angeles during a recent visit. 'We can help these women all over Africa and the developing world, but we need support.'

A sign of growing support came in 2002 when the U.N. Population Fund announced its global 'Campaign to End Fistula' in 18 developing countries. But when George W. Bush cut off $34 million earmarked for the population fund because of concern that it was promoting abortion, monies for preventing and treating fistulas also got cut. The '34 Million Friends' campaign ( was launched by Jane Roberts and Lois Abraham with the aim of getting people to donate $1 each to replace the money Bush cut. It has already funneled some funds to fistula treatment.

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