Gut-Level Healing

Obstetric fistula could be a curse from the book of Job, if Job were a woman: A girl or woman is in labor in rural Africa. Forced to marry when still a child, she is only 13 or 14. Or she is 18 or 20, but malnutrition has stunted her growth. Her pelvis is too small to allow the baby to pass, and she has at most a traditional birth attendant to help her; her obstructed labor lasts days. Sometime during this agony the baby dies, and, eventually, the lifeless body is delivered. The mother, exhausted and grieving, might assume the worst of her physical suffering is over. Then she discovers that the worst may have just begun.

The prolonged pressure of the baby’s head in the birth canal killed tissue, causing a hole between the vagina and bladder or rectum. Urine or feces leak constantly. The odor becomes overwhelming. The woman is likely rejected by her husband. Without medical help, she spends the rest of her life on the fringes of her community.

Precise counts aren’t available, but an estimated 2 million women have obstetric fistula worldwide. Between 50,000 and 100,000 new cases occur each year, mostly in sub-Saharan Africa and parts of Asia. Fistula is virtually nonexistent in countries with widely available emergency obstetric care. Most fistulas occur in childbirth, but others come from the use of rape as a weapon of war, as in Congo and Sierra Leone.

The root causes of fistula are extreme poverty, inadequate health care, and the low social status of women, which deny them basic rights, education, and the capacity for self-determination. For example, when girls are allowed to continue their education at least through adolescence and delay marriage until adulthood, their risk of complicated childbirth is drastically lowered.

Key to reducing fistula is the improvement of women’s health care in the poorest part of the world—creating a network of medical facilities, identifying and monitoring pregnant women susceptible to birth complications, and training surgeons to treat the many who are already injured. A relatively brief operation, costing only about $300, can repair fistula in 60 to 90 percent of cases. Facilities such as the Addis Ababa Fistula Hospital in Ethiopia, which I visited in 2006, do nothing less than give girls and women their lives back. It is featured in the award-winning documentary A Walk to Beautiful, an engaging and inspiring window into the experience of women with fistula.

Worldwide, only a few thousand women a year receive treatment for fistula. Dr. Lewis Wall, founder of the Worldwide Fistula Fund (WFF) and a professor of obstetrics and gynecology at Washington University in St. Louis, proposes a major initiative: A 13-year program creating 40 fistula treatment and prevention outreach centers throughout Africa. The estimated cost—$1.5 billion over 13 years—is equivalent to less than 4 percent of the money the U.S. government has committed to fighting HIV/AIDS over just the next five years. Wall is partnering with Michael Horowitz of the Hudson Institute to build a broad coalition reaching across right-left and religious-secular divides to support this initiative.

As Wall, who is a Christian, writes of fistula repair surgery, “The affluent world needs to understand the profound impact that $300 can have on the lives of these impoverished, suffering women. The ‘widow’s mite’ is not only noble; when used in the right way it can be world-shaking.”

A new United Methodist campaign, Operation Healing Hope, is developing faith-based resources to raise awareness and promote action on fistula among church members. And Addis Ababa Fistula Hospital, WFF, and many other organizations have joined forces with the United Nations Population Fund in the Campaign to End Fistula. Visit to see how you can help the cause.

Julie Polter is an associate editor of Sojourners.

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