I 
114TH CONGRESS 
1ST SESSION H. R. 4148 
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 
DECEMBER 1, 2015 
Mrs. CAROLYN B. MALONEY of New York (for herself, Mr. GRIJALVA, Mr. 
JOHNSON of Georgia, Ms. MOORE, and Mr. CONYERS) introduced the fol-
lowing 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 2015’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Every two minutes, one woman dies from 
pregnancy-related complications. 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. Most of these deaths are 
preventable, which represents both a tragedy and an 
opportunity. 
(2) For every woman who dies from pregnancy- 
related complications, an estimated 20 women sur-
vive but experience pregnancy-related disabilities. 
One of the most severe is obstetric fistula, which oc-
curs when a woman who is experiencing prolonged, 
obstructed labor and needs trained medical assist-
ance for a safe delivery, usually a cesarean section, 
cannot get it. 
(3) Obstetric fistula is a hole that is formed be-
tween the bladder and the vagina, or the rectum and 
the vagina (or both), after a woman suffers from 
prolonged, obstructed labor without timely, adequate 
medical intervention. 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 
sloughs off, resulting in the abnormal opening or 
hole. 
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(4) In the majority of obstetric fistula cases, 
the baby will be stillborn and the mother will experi-
ence physical pain and disability, as well as social 
and emotional trauma from living with incontinence 
and from the loss of her child. 
(5) In addition to incontinence or constant un-
controllable leaking of urine, feces, or both, the 
physical consequences of obstetric fistula may in-
clude frequent bladder infections, infertility, foul 
odor, and nerve damage. 
(6) Mental, emotional, and social side effects of 
obstetric fistula may include depression, social isola-
tion and discrimination, suicidal thoughts or actions, 
and lack of adequate economic opportunities, result-
ing in deepening poverty and vulnerability. Girls 
with obstetric fistula are also often unable to con-
tinue schooling. Women and girls with fistula suffer 
psychological consequences, such as feelings of hope-
lessness because of stigma and lack of awareness 
that their condition is treatable. Fistula survivors 
need regular medical attention and support, but too 
often adequate services are unavailable or the 
women and their families cannot afford them. 
Women may lose property if they are divorced or 
abandoned by their husbands and family. Some lose 
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