IV 
108TH CONGRESS 
1ST SESSION 
H. RES. 447
Recognizing the horrific effects of obstetric fistulas and urging that programs 
be initiated to prevent and treat obstetric fistulas. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 18, 2003
Mr. TOWNS (for himself, Ms. NORTON, Mrs. CHRISTENSEN, Ms. LEE, Ms. 
JACKSON-LEE of Texas, Mr. LANTOS, Mr. WAXMAN, Ms. SCHAKOWSKY, 
Mr. OWENS, Mr. BISHOP of Georgia, and Mr. SCOTT of Georgia) sub-
mitted the following resolution; which was referred to the Committee on 
Energy and Commerce, and in addition to the Committee on Inter-
national Relations, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
RESOLUTION 
Recognizing the horrific effects of obstetric fistulas and urg-
ing that programs be initiated to prevent and treat ob-
stetric fistulas.
Whereas each minute a woman dies from pregnancy-related 
complications; 
Whereas for every woman who dies from pregnancy-related 
complications, between 15 to 30 live but suffer chronic 
disabilities, the worst of which are obstetric fistulas; 
Whereas between 1,000,000 and 3,000,000 women are esti-
mated to suffer from obstetric fistulas worldwide;
•HRES 447 IH 
Whereas obstetric fistulas usually occur in young, first-time 
mothers; 
Whereas although currently virtually unknown in the Western 
World, obstetric fistulas were once common in the United 
States and Europe before the advent of widespread ma-
ternal health care and hospital births; 
Whereas obstetric fistulas occur when a woman is in ob-
structed and prolonged labor without medical help; 
Whereas the prolonged pressure of the baby’s head against 
the mother’s pelvis cuts off the blood supply to the soft 
tissues surrounding her bladder, rectum, and vagina; 
Whereas the prolonged and difficult labor that causes obstet-
ric fistulas usually results in the death of the baby; 
Whereas if the mother survives such prolonged labor the in-
jured tissue will rot away leaving a perforation, or fistula, 
which causes the woman to lose control of urination and 
bowel function; 
Whereas because of a lack of understanding about the cause 
and treatment of obstetric fistulas, women who suffer 
from obstetric fistulas are often abandoned by their hus-
bands, forced out of their homes, and ostracized by their 
families; 
Whereas a recent report commissioned by the United Nations 
Population Fund (UNFPA) titled ‘‘Obstetric Fistula 
Needs Assessment: Findings from Nine African Coun-
tries’’ details obstetric fistula occurrence in nine coun-
tries in sub-Saharan Africa: Benin, Chad, Malawi, Mali, 
Mozambique, Niger, Nigeria, Uganda, and Zambia; 
Whereas 35 hospitals in such countries have the capacity to 
conduct surgeries to repair obstetric fistulas, but lack the 
financial resources to do so;
•HRES 447 IH 
Whereas reconstructive surgery can end the suffering associ-
ated with obstetric fistulas; 
Whereas a reconstructive surgery for obstetric fistulas devel-
oped in the 1850’s by Dr. James Sims, a surgeon in 
South Carolina, has up to a 90 percent success rate; 
Whereas the cost of such a surgery is between $100 and 
$400; and 
Whereas most women in developing countries are unaware of 
treatment options, unable to access treatment, or unable 
to afford treatment: Now, therefore, be it
Resolved, That the House of Representatives—
(1) recognizes the horrific effects of obstetric 
fistulas on the lives of women who experience them 
as they seek to become mothers; and 
(2) urges the appropriate Federal agencies to 
work with foreign agencies and organizations to im-
plement programs to provide maternal health care, 
especially the prevention and treatment of obstetric 
fistulas.
Æ