I 
115TH CONGRESS 
2D SESSION 
H. R. 5068 
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 
FEBRUARY 16, 2018 
Mrs. CAROLYN B. MALONEY of New York introduced the following bill; which 
was referred to the Committee on Foreign Affairs 
A BILL 
To authorize assistance to aid in the prevention and treat-
ment of obstetric fistula in foreign countries, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Obstetric Fistula Pre-
vention, Treatment, Hope, and Dignity Restoration Act 
of 2018’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Every two minutes, one woman dies from 
pregnancy-related complications. This means ap-
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proximately 830 women die from pregnancy- or 
childbirth-related complications around the world 
every day. Of these deaths, 99 percent occur in de-
veloping countries. Over half of these deaths are in 
sub-Saharan Africa and one-third are in South Asia. 
(2) 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, nec-
essary for a safe delivery. 
(3) Obstetric fistula is a hole that is formed be-
tween 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 vag-
inal or rectal walls, destroying the tissue that then 
dies and sloughs off, resulting in the abnormal open-
ing or hole. 
(4) In approximately 90 percent of obstetric fis-
tula cases, the baby will be stillborn. A mother will 
experience physical pain and multiple physical dis-
abilities, as well as social and emotional trauma 
from living with incontinence and from the loss of 
her child. 
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(5) In addition to constant uncontrollable leak-
ing of urine, feces, or both, the physical conse-
quences of obstetric fistula may include frequent 
bladder infections, painful sores, kidney failure, in-
fertility, foul odor, orthopedic injury, nerve damage 
that makes normal walking impossible and internal 
genital scarring that destroys normal sexual func-
tion. 
(6) Women and girls with obstetric fistula are 
commonly ostracized by their families and commu-
nities, 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 pov-
erty, isolation, and vulnerability. 
(7) Although data on obstetric fistula are 
scarce, the World Health Organization (WHO) esti-
mates there are more than 2,000,000 women and 
girls living with fistula, and 50,000 to 100,000 new 
cases each year. 
(8) Obstetric fistula was once common through-
out the world, but over the last century has been vir-
tually eliminated in Europe, North America, and 
other developed regions through improved access to 
high-quality, timely medical interventions, particu-
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