The GiveWell Blog


Coming across the current feature on the DCPP’s home page reminds me of how much I care about the issue of obstetric fistula.

The following are highlights from the article linked above (emphasis mine):

For countless women in developing countries, going into labor is the painful beginning of a lifetime of unremitting shame and misery as a despised social outcast—destitute, childless, and abandoned by family and friends.

These women have a condition called obstetric fistula. A fistula, the Latin word for “pipe,” is an “abnormal passage” between organs — in this case, between the vagina and the bladder, the rectum, or both. The hole makes the woman uncontrollably incontinent of urine or feces or both and transforms a healthy person into someone viewed as a leaking, reeking, “moving latrine,” in the words of Veronica Yakobe, a Malawian woman who endured 23 years of indignity before an operation at Nkhoma Hospital in her country’s central region closed the fistula.

  • 2 million to 3.5 million women worldwide currently [live] with obstetric fistula.
  • Statistics from Ethiopia, Nigeria, India, Pakistan, and elsewhere show that the majority of fistula sufferers are abandoned by their families, divorced by their husbands, and forced to fend for themselves, often by begging. Some, like a group of Somali women who leapt from a pier chained to one another, end their lives in despair.
  • Studies of patients undergoing fistula surgery find the majority in their early twenties or younger. In one Nigerian study, 72 percent were between the ages of 10 and 20, 82 percent having married between 10 and 15.
  • A number of facilities, most prominently the renowned Addis Ababa Fistula Hospital, in Ethiopia, repair thousands of fistulas each year at a cost of about $450 for each operation and related care.

The disability weight used for fistula in DALY calculations is .430 (Pg 121 of the Global Burden of Disease report (PDF)). For context, the disability weight for blindness is .600 (Pg 120). To me, fistula seems much worse. Not only does a person undergo severe physical trauma, but she also often suffers severe social consequences such as communal ostracization and abandonment by her family.

In fact, it’s hard for me to imagine a cause I’d rather attack. I’d much rather prevent a fistula than save a life. The fate described above seems worse than death.

We’re planning to look into fistula carefully, and I hope we’ll find donors a great option for helping those afflicted.


  • jsalvati on August 20, 2008 at 10:13 pm said:

    What you describe seems terrible indeed. However, death seems much worse to me than Fistula.

  • Dr. Ethiopia on August 21, 2008 at 4:23 pm said:

    It is an absolute hell-on-earth for these women.

  • Ron Noble on August 27, 2008 at 3:09 pm said:


    I admire your compassion for women suffering from fistulas. I wonder how many women with fistulas end up commiting suicide. Suicide is the ultimate statement that one’s quality of life was perceived as worse than death. On the other hand, if a woman decides to go on living with a fistula, isn’t she saying that for her, being alive is still preferable? Of course, fear of the moment of death or moral objections to suicide might figure into this.

    The disability weight might possibly already take the social ostracism into account, and if it doesn’t, it should.

    It is my understanding that this condition is also often created by severe rapes, and that thousands of women in the Democratic Republic of Congo have acquired fistulas in this manner.

  • Wow that sounds like a tragically painful disease. I agree with Dr Ethiopia… hell on earth.

  • Alice Chase on January 25, 2009 at 7:49 pm said:

    Wow, sounds terrible. I am involved in selling incontinence products and I’ve never heard of this condition. Thank god it’s rare.

  • Diaper Dan on February 17, 2009 at 10:22 am said:

    I was researching more information on fistula and found your blog.

    We also sell medical supplies for incontinence and have only had one person mention this condition. Most people buying adult diapers don’t tell you their history, so it could have been more common than I knew about.

  • Seth Cochran on February 18, 2009 at 9:48 am said:

    I run a charity focused on fistula. Its an awful fate and the women who endure this tragedy have an awe inspiring strength. check out my website

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