I 

111TH CONGRESS 

2D SESSION H. R. 5441 

To authorize assistance to aid in the prevention and treatment of obstetric 

fistula in foreign countries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 27, 2010 

Mrs. MALONEY (for herself, Mr. CASTLE, and Mrs. CAPPS) introduced the 

following bill; which was referred to the Committee on Foreign Affairs 

A BILL 

To authorize assistance to aid in the prevention and treatment of obstetric fistula in foreign countries, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Obstetric Fistula Pre5 vention, Treatment, Hope, and Dignity Restoration Act 

6 of 2010’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 

9 (1) Every minute, one woman dies from preg10 nancy-related complications. Of these deaths, 99 


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1 percent occur in the developing world and 95 percent 

2 occur in Africa and Asia. 

3 (2) For every woman who dies from pregnancy4 related complications, an estimated 20 women sur5 vive but experience pregnancy-related disabilities. 

6 One of the most severe is obstetric fistula, which oc7 curs when a woman who needs trained medical as8 sistance for a safe delivery, usually a cesarean sec9 tion, cannot get it. 

10 (3) Obstetric fistula is a hole that is formed be11 tween the bladder and the vagina, or the rectum and 

12 the vagina (or both), after a woman suffers from 

13 prolonged obstructed labor. In the struggle to pass 

14 through the birth canal, the fetus puts constant 

15 pressure, sometimes for several days, on the bladder 

16 and vaginal or rectal walls, destroying the tissue 

17 that then sloughs off, resulting in the abnormal 

18 opening. 

19 (4) In the majority of obstetric fistula cases, 

20 the baby will be stillborn and the mother will experi21 ence physical pain as well as social and emotional 

22 trauma from living with incontinence as well as the 

23 loss of her child. 

24 (5) The physical symptoms of obstetric fistula 

25 include incontinence or constant uncontrollable leakVerDate Mar 15 2010 23:39 Jun 02, 2010 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5441.IH H5441

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1 ing of urine or feces, frequent bladder infections, in2 fertility, and foul odor. 

3 (6) Although data on obstetric fistula are 

4 scarce, the World Health Organization (WHO) esti5 mates there are more than 2,000,000 women living 

6 with fistula and 50,000 to 100,000 new cases each 

7 year. 

8 (7) According to the United States State De9 partment, ‘‘The combination of pregnancy at an 

10 early age, chronic maternal malnutrition, and a lack 

11 of skilled care at delivery can all contribute to the 

12 development of obstetric fistula and permanent in13 continence.’’. 

14 (8) Obstetric fistula was once common through15 out the world, but over the last century was elimi16 nated in Europe, North America, and other devel17 oped regions through improved access to medical 

18 interventions, particularly emergency obstetric care 

19 for those women who need it. 

20 (9) The social consequences for women living 

21 with obstetric fistula include isolation, divorce or 

22 abandonment, ridicule and shame, inability to start 

23 a family, illness, risk of violence, and lack of oppor24 tunity. 


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1 (10) Obstetric fistula is preventable through 

2 medical interventions such as skilled attendance 

3 present during labor and childbirth, providing access 

4 to family planning, and emergency obstetric care for 

5 women who develop childbirth complications as well 

6 as social interventions such as delaying early mar7 riage and educating and empowering young women. 

8 (11) Obstetric fistula can also be surgically 

9 treated. Surgery requires a specially trained surgeon 

10 and support staff, and access to an operating the11 ater and to attentive postoperative care. When per12 formed by a skilled surgeon, success rates can be as 

13 high as 90 percent and cost an estimated $300. 

14 (12) According to the Department of State, 

15 ‘‘Because of their roles in child rearing, providing 

16 and seeking care, and managing water and nutri17 tion, the ability of women to access health-related 

18 knowledge and services is fundamental to the health 

19 of their babies, older children and other family mem20 bers. Over the long-term, the health of women en21 hances their productivity and social and economic 

22 participation and also acts as a positive multiplier, 

23 benefitting social and economic development through 

24 the health of future generations.’’. 


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1 (13) In 2002, the United Nations Population 

2 Fund (UNFPA) and EngenderHealth embarked on 

3 the first ever assessments in nine African countries 

4 to determine the need for and access to services to 

5 address obstetric fistula. In 2003, UNFPA and 

6 partners launched a global campaign to identify and 

7 address obstetric fistula in an effort to develop a 

8 means to treat those women who are suffering and 

9 provide the necessary health services to prevent fur10 ther cases. The campaign is currently active in more 

11 than 45 countries in Africa, Asia, and the Arab 

12 States region through support for fistula surgery, 

13 training of doctors and nurses, equipping hospitals, 

14 and undertaking community outreach to prevent fur15 ther cases, and supporting provision of rehabilitative 

16 care for women after treatment so they can return 

17 to full and productive lives. 

18 (14) The global Campaign to End Fistula 

19 works with national counterparts, including min20 istries of health, other pertinent ministries, United 

21 Nations agencies, international and national non22 governmental organizations, civil society organiza23 tions, and fistula providers, in support of national 

24 processes and fistula programmatic efforts. A key 

25 focus is national fistula capacity strengthening. 


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1 (15) In 2004, USAID provided funding through 

2 the ACQUIRE Project managed by EngenderHealth 

3 to support services in two countries, Bangladesh and 

4 Uganda. In 2007, USAID provided a five-year coop5 erative agreement to EngenderHealth for the Fistula 

6 Care project. USAID currently supports fistula 

7 treatment services in 34 sites in 11 countries and 

8 addresses prevention in those sites and 25 more. 

9 The ceiling for the Fistula Care project is 

10 $70,000,000. 

11 (16) One of the key global health principles of 

12 the United States Global Health Initiative is to 

13 strengthen and leverage key multilateral organiza14 tions, global health partnerships, and private sector 

15 engagement. The United States has committed to 

16 join multilateral efforts involving the United Nations 

17 and others to make progress toward achieving Mil18 lennium Development Goals 4, 5, and 6. 

19 (17) By 2014, the United States through its 

20 Global Health Initiative has committed to several 

21 targets that will reduce the incidence of fistula, in22 cluding through efforts to reduce maternal mortality 

23 by 30 percent; prevent 54,000,000 unintended preg24 nancies by reaching a modern contraceptive preva25 lence rate of 35 percent; and reducing to 20 percent 


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1 the number of first births by women under 18 across 

2 assisted countries. 

3 SEC. 3. PREVENTION AND TREATMENT OF OBSTETRIC FIS4 TULA. 

5 (a) AUTHORIZATION.—The President is authorized, 

6 in accordance with this section and section 4, to provide 

7 assistance, including through international organizations, 

8 national governments, and international and local non9 governmental organizations, to— 

10 (1) address the social and health issues that 

11 lead to obstetric fistula; and 

12 (2) support treatment of obstetric fistula. 

13 (b) ACTIVITIES.—Assistance provided pursuant to 

14 subsection (a) shall focus on— 

15 (1) increasing prevention through access to sex16 ual and reproductive health services, including 

17 skilled attendance at birth, comprehensive emer18 gency obstetric care, prenatal and antenatal care, 

19 and contraception (family planning); 

20 (2) building local capacity and improving na21 tional health systems to prevent and treat obstetric 

22 fistula within the context of navigating pregnancy in 

23 good health overall; 

24 (3) supporting tools to enable countries to ad25 dress fistula, including supporting qualitative reVerDate Mar 15 2010 23:39 Jun 02, 2010 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5441.IH H5441

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1 search, development of sustainable financing mecha2 nisms, training of skilled birth attendants, pro3 moting ‘‘south-to-south’’ training, and provision of 

4 basic obstetric care at the community level; 

5 (4) addressing underlying social and economic 

6 inequities, including empowering women and girls, 

7 reducing incidence of child marriage, delaying child8 birth, and increasing access to formal and non-for9 mal education; and 

10 (5) supporting reintegration and training pro11 grams to help women who have undergone treatment 

12 return to full and productive lives. 

13 SEC. 4. COORDINATION, REPORTING, RESEARCH, MONI14 TORING, AND EVALUATION. 

15 (a) IN GENERAL.—Assistance authorized under this 

16 Act shall— 

17 (1) promote the coordination facilitated by the 

18 International Obstetric Fistula Working Group, 

19 which coordinates between and among donors, multi20 lateral institutions, the private sector, nongovern21 mental and civil society organizations, and govern22 ments in order to support comprehensive prevention 

23 and treatment of obstetric fistula; and 

24 (2) be used for the development and implemen25 tation of evidence-based programs, including moniVerDate Mar 15 2010 23:39 Jun 02, 2010 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5441.IH H5441

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1 toring, evaluation, and research to measure the ef2 fectiveness and efficiency of such programs through3 out their planning and implementation phases. 

4 (b) REPORTING.—Not later than December 31, 2011, 

5 and annually thereafter, the President shall transmit to 

6 Congress a report on activities undertaken pursuant to 

7 this Act during the preceding fiscal year to reduce the inci8 dence of and increase treatment for obstetric fistula, and 

9 how such activities fit into existing national action plans 

10 to prevent and treat obstetric fistula. 

Æ 


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