jobs or are denied work, while others may quit their 
jobs out of shame, leading to deepened poverty and 
vulnerability to repeat fistulas. 
(7) Although data on obstetric fistula are 
scarce, the World Health Organization (WHO) esti-
mates there are more than 2,000,000 women living 
with fistula, and 50,000 to 100,000 new cases each 
year. 
(8) The primary cause of obstetric fistula is a 
lack of timely, adequate emergency obstetric care, 
such as a cesarean section. Poverty, malnutrition, 
poor health services, early childbearing, and gender 
discrimination are interlinked root causes of obstet-
ric fistula. 
(9) Obstetric fistula was once common through-
out the world, but over the last century was elimi-
nated in Europe, North America, and other devel-
oped regions through improved access to medical 
interventions, particularly emergency obstetric care 
for those women who need it. The first fistula hos-
pital in the world stood where the Waldorf-Astoria 
Hotel is now located in New York City. As high-
lighted by the United Nations Secretary General in 
his 2015 statement on the occasion of the Inter-
national Day to End Obstetric Fistula (May 23rd), 
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in which he called upon world leaders to commit to 
ending the scourge of obstetric fistula in our life-
time, ‘‘The fact that fistula persists primarily among 
the poorest and most marginalized women and girls 
in the world is an egregious outcome of social, eco-
nomic and gender inequalities, the denial of human 
rights and inadequate access to quality reproductive 
health services, including maternal and newborn 
care.’’. 
(10) Obstetric fistula is preventable through 
medical interventions, such as skilled attendance, in-
cluding midwives, present during labor and child-
birth, providing access to family planning, and emer-
gency obstetric care for women who develop child-
birth complications, as well as social interventions 
such as delaying early marriage and educating and 
empowering young women. 
(11) The majority of obstetric fistula can be 
surgically treated. Surgery requires a specially 
trained, qualified surgeon and support staff, and ac-
cess to an operating theater and to attentive post-
operative care. When performed by a skilled, com-
petent surgeon, success rates can be as high as 90 
percent and cost an estimated $400. 
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(12) According to the Department of State, 
‘‘Because of their roles in child rearing, providing 
and seeking care, and managing water and nutri-
tion, the ability of women to access health-related 
knowledge and services is fundamental to not only 
their own health and well-being, but also that of 
their babies, older children and other family mem-
bers. Over the long-term, the health and well-being 
of women, in addition to being essential in its own 
right, enhances their productivity and social and eco-
nomic participation and also acts as a positive multi-
plier, benefitting social and economic development 
through the health of future generations.’’. 
(13) In 2002, the United Nations Population 
Fund (UNFPA) and EngenderHealth embarked on 
the first ever assessments in nine African countries 
to determine the need for and access to services to 
address obstetric fistula. In 2003, UNFPA and 
partners launched a global campaign to identify and 
address obstetric fistula in an effort to develop a 
means to treat and support those women who are 
suffering and provide the necessary health services 
to prevent further cases. The UNFPA-led Campaign 
to End Fistula is now present in more than 50 
countries across Africa, Asia, and the Arab region 
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and is comprised of over 90 partners at the global 
level and many more at the regional and national 
levels. The Campaign has three main focuses: the 
prevention of fistula cases, treatment of existing 
cases of fistula, and social reintegration and follow 
up for fistula survivors. The Campaign supports fis-
tula surgery, training of doctors, nurses, and other 
health workers, community outreach to prevent fur-
ther cases, identification of women suffering fistula 
who need care, and supporting provision of rehabili-
tative care for women after treatment in order to 
break the cycle of poverty and marginalization that 
rendered them vulnerable to fistula in the first place 
and to enable them to reclaim their dignity and hope 
and return to full and productive lives. Since 2003, 
UNFPA has directly supported more than 57,000 
fistula repairs, and additional repairs have been sup-
ported by Campaign partners. 
(14) The Campaign to End Fistula works with 
national counterparts, including ministries of health, 
other pertinent ministries, United Nations agencies, 
international and national nongovernmental organi-
zations, civil society organizations, academic institu-
tions, and health providers (and professional associa-
tions), in support of national processes and fistula 
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eradication efforts, including strategies to eradicate 
end-stage prolonged or obstructed labor that causes 
not only fistula, but a host of newborn and maternal 
reproductive, mental, neurologic and orthopedic con-
ditions, that have detrimental consequences for wom-
en’s lives. A key focus is national capacity strength-
ening to reach the regional backlogs of women living 
with fistula in remote regions, suffering needlessly, 
sometimes for decades. 
(15) In 2004, the United States Agency for 
International Development (USAID) provided fund-
ing through the ACQUIRE Project managed by 
EngenderHealth to support services in Bangladesh 
and Uganda. From 2007 to 2013, USAID funded 
the Fistula Care project, and in 2013, USAID 
awarded a new 5-year cooperative agreement to 
EngenderHealth for the Fistula Care Plus project to 
support national fistula programs in Africa and 
Asia, expand access to care, assess the backlog of 
cases, test new approaches to improve the efficiency 
and quality of care, and improve health outcomes. 
USAID currently supports fistula treatment services 
in 137 sites in six countries and addresses preven-
tion in those sites and 36 more. The ceiling for the 
Fistula Care Plus project is $74,490,000. Since 
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2004, more than 39,000 women have received fistula 
repairs with USAID support. 
(16) One of the key global health principles of 
the United States Global Health Initiative is to 
strengthen and leverage key multilateral organiza-
tions, global health partnerships, and private sector 
engagement. The United States has committed to 
join multilateral efforts involving the United Nations 
and others to make progress toward achieving Mil-
lennium Development Goals 4, 5, and 6, and there-
after the Sustainable Development Goals, through 
the United Nations Secretary General’s Every 
Woman Every Child initiative. 
(17) The United States, through its commit-
ment to Ending Preventable Maternal and Child 
Deaths, has set several targets that will reduce the 
incidence of fistula, including through efforts to re-
duce maternal mortality to 50 maternal deaths per 
100,000 live births by 2035, and support voluntary 
family planning and reproductive health programs to 
reach 120,000,000 additional women and girls with 
family planning information, commodities and serv-
ices by 2020. The USAID Maternal Health Vision 
for Action calls for an increased focus on averting 
and addressing maternal morbidity and disability. 
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SEC. 3. PREVENTION AND TREATMENT OF OBSTETRIC FIS-
TULA. 
(a) AUTHORIZATION.—The President is authorized, 
in accordance with this section and section 4, to provide 
assistance, including through international organizations, 
national governments, and international and local non-
governmental organizations, to— 
(1) address the social and health issues that 
lead to obstetric fistula; and 
(2) support treatment of obstetric fistula. 
(b) ACTIVITIES.—Assistance provided pursuant to 
subsection (a) shall focus on— 
(1) increasing prevention through access to sex-
ual and reproductive health services, including 
skilled attendance at birth, comprehensive emer-
gency obstetric care, prenatal and antenatal care, 
contraception (family planning), and supporting 
comprehensive sexuality education; 
(2) building local capacity and improving na-
tional health systems to prevent and treat obstetric 
fistula within the context of navigating pregnancy in 
good health overall; 
(3) supporting tools to enable countries to ad-
dress obstetric fistula, including supporting quali-
tative research and data collection on the incidence 
and prevalence of obstetric fistula, development of 
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sustainable financing mechanisms to encourage facil-
ity deliveries and provide fistula survivors access to 
free or affordable treatment, training of midwives 
and skilled birth attendants, promoting ‘‘south-to- 
south’’ training, and provision of basic obstetric care 
at the community level; 
(4) addressing underlying social and economic 
inequities, including empowering women and girls, 
reducing incidence of child marriage, delaying child-
birth, and increasing access to formal and nonformal 
education; 
(5) supporting reintegration and training pro-
grams to help women who have undergone treatment 
return to full and productive lives; and 
(6) promoting public awareness to increase un-
derstanding of obstetric fistula, and thereby improve 
prevention and treatment efforts, to help reduce 
stigma and violence against women and girls with 
obstetric fistula. 
SEC. 4. COORDINATION, REPORTING, RESEARCH, MONI-
TORING, AND EVALUATION. 
(a) IN GENERAL.—Assistance authorized under this 
Act shall— 
(1) promote the coordination facilitated by the 
International Obstetric Fistula Working Group, 
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which coordinates between and among donors, multi-
lateral institutions, the private sector, nongovern-
mental and civil society organizations, and govern-
ments in order to support comprehensive prevention 
and treatment of obstetric fistula; and 
(2) be used for the development and implemen-
tation of evidence-based programs, including moni-
toring, evaluation, and research to measure the ef-
fectiveness and efficiency of such programs through-
out their planning and implementation phases. 
(b) REPORTING.—Not later than one year after the 
date of the enactment of this Act and annually thereafter, 
the President shall transmit to Congress a report on ac-
tivities undertaken pursuant to this Act during the pre-
ceding fiscal year to reduce the incidence of and increase 
treatment for obstetric fistula, and how such activities fit 
into existing national action plans to prevent and treat ob-
stetric fistula. 
Æ 
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