The GiveWell Blog

Can a donor give “new life for the pariahs” through the World Fistula Fund?

Nicholas Kristof’s excellent column describes the problem of obstetric fistula and the World Fistula Foundation.

We strongly share Mr. Kristof’s view that obstetric fistula is a pressing problem, and have written before that it’s one of the problems we’d most like to help donors address.

However, we still have not identified a fistula charity that we can be highly confident in. Here’s what we do know about the Worldwide Fistula Fund (WFF), the charity discussed in the column:

We’re confident that WFF is a legitimate operation working hard to address the problem of obstetric fistula. We’ve had significant back-and-forth with Dr. Lewis Wall, the founder and President of the Worldwide Fistula Fund.

Obstetric fistula is correctable, but the surgery is complex and may have a high failure rate. More at our discussion of the condition of obstetric fisula.

WFF’s current initiative is building specialized fistula facilities. The proposed plan (PDF) states that “cases such as fistula repair are chronically “bumped” from the surgical schedule by a continuous string of emergencies,” and thus that “without dedicated
facilities for fistula surgery, these operations will never get done.”

Is it the case that regular hospitals are unwilling or unable to treat fistulas reliably? Or might this approach represent an unnecessary diversion of resources from other pressing health problems (for example, pneumonia)? Especially if WFF’s focus is on lobbying the government to reallocate funding rather than using donations to increase total aid flows? At this point we don’t have the information to say.

We don’t know:

  • The skill level of the surgeons that will be working at WFF’s new facilities, or the success/complication rate of their surgeries. Hopefully this information will become available in the future.
  • The full story of what happens to the women who get corrective surgery. We have some information about the medical benefits of surgery, but very little about the social implications. To what extent can a “pariah” be re-accepted into her community?


  • I’m new to this blog and new as well to the world of Global Health, so excuse my possibly ignorant questions:
    In terms of “We don’t know” and how women can be re-integrated into a community, does it really matter? Everything I’ve read about obstetric fistula focuses on the debilitating condition the women are in. As long as we can try to fix this problem, how much does it matter if the women are re-integrated? Raped women/mutilated women are already on the fringes of society. Just because the society won’t necessarily help them doesn’t mean we need to forget the problem.

  • Holden on November 2, 2009 at 4:43 pm said:

    Yael, I completely agree that “Just because the society won’t necessarily help them doesn’t mean we need to forget the problem.”

    We do not advocate “forgetting” any problem. We do advocate that donors compare their options for giving and give where they can do as much good as possible. For that purpose, it matters whether a fistula surgery fully or partially mitigates a woman’s suffering.

Comments are closed.