Effective altruism is an approach to philanthropic giving that focuses on maximizing the good from one’s charitable donations. This evidence-based approach first identifies issues where the next dollar spent could have the greatest impact on human welfare, and then supports the most effective charities tackling these issues.
In his book, The Life You Can Save, Princeton ethicist Peter Singer asserts charities operating effectively in low-resource countries—where poverty and its effects are most pronounced—are best positioned to make the largest impact.
Since 2014, The Life You Can Save organization has recommended Fistula Foundation as one of its Top Charities that it believes provides the greatest good for funds spent. Named after Singer’s seminal book, this watchdog organization is one of the nonprofit sector’s most authoritative voices on Effective Altruism.
From a health metrics standpoint, healing a woman with fistula is a highly effective intervention—comparing favorably with vaccines and bed nets. Obstetric fistula is one of humanity’s most disabling injuries, but it can be cured by a surgery that costs $586.
- Peter Singer’s TED Talk: The Why and How of Effective Altruism
- The Atlantic Magazine: The Greatest Good
- Forbes: Making The Most Impact When You Donate
- Wikipedia: Effective Altruism
The average cost per patient is $586 USD. This includes surgery, postoperative care and physical rehabilitation. This price estimate is based on data reported to Fistula Foundation by our grantees across Africa and Asia. Costs and hospitalization can, however, be far greater for more complicated surgeries such as treating dual vaginal and rectal fistulas. You can learn more about how we determine the average cost of care on
Fistula Foundation was founded in 2000 as an all volunteer organization to support the pioneering Addis Ababa Fistula Hospital in Ethiopia.
Our success between 2004 and 2008 enabled us to dramatically expand our mission in 2009 to fight fistula globally. As a result of this rapid expansion, we have now supported fistula treatment in 32 countries at sites on two continents, Africa and Asia. We fund more obstetric fistula surgeries globally than any other organization.
There were a number of worthy approaches we could have pursued in the fight against fistula, including midwifery training, contraceptive provision, and eliminating child marriage. But one path—providing curative fistula surgery—stood out from these approaches with two clear advantages:
- the unmet need to treat women already injured with fistula is profound
- the marginal difference surgery can provide is truly life-changing.
This enormous return on investment is precisely why Fistula Foundation focuses solely on delivering fistula repair surgery. With each surgery we provide, we know that we’re helping change one woman’s world forever. And we know that the ripple effect of her restored health—on both her family and community—is profound. Learn more about
We do our homework upfront and only invite funding requests from the very best hospitals and doctors, some of whom operate in the world’s toughest neighborhoods. We never lose sight of the fact that we’re not buying widgets—we’re selecting surgeons to perform intricate, vaginal surgery on horribly injured women. Cost is not the key variable; the quality and training of the medical team is.
We vet potential partners through a careful process that draws on the expertise of the Foundation’s Program Development team, Board of Directors, and Grants Review Committee. We also rely on our relationships with Direct Relief and an international network of fistula surgeons who help advise on the reputations of local doctors and the needs that exist in different regions.
We currently partner with 47 carefully vetted hospitals and surgical teams in 24 countries. We have worked with these partners for on average six years. Every day, these extraordinary doctors are hard at work across sub-Saharan Africa and Asia, helping women in the world’s poorest regions, some in war zones. These heroes are people like 2018 Nobel Peace Prize winner Dr. Denis Mukwege, who treats women injured by violence and childbirth in his native Democratic Republic of the Congo; midwife Edna Adan who runs a maternity hospital built with her own life savings and which today shines as a beacon of hope in Somaliland, one of the hardest places to be a woman; and an all-female team of fistula surgeons at Cure Hospital, run by Be Team International in Afghanistan, where cultural norms can significantly constrain the delivery of maternal health services and a woman may have no choice but to go without treatment if a female doctor is not available.
We are committed to helping women with fistula, both in the short term by providing as many cost-free surgeries as possible, and in the long term through our proven evidence-based strategy to eliminate the condition for good on a country-by-country basis.
Goal 1: Strengthen local capacity at individual hospitals in Africa and Asia to treat as many women as possible
Our first goal is to provide immediate relief to women in areas of the greatest need. Rather than working through intermediaries, we partner directly with established, in-country hospitals and surgical teams who understand how best to serve women in their communities. In addition to paying for the direct costs of fistula repair surgery, we strengthen the efforts of these local experts, equip hospitals to provide high-quality fistula care, and use grassroots community outreach to reach as many suffering women as possible. This strategy has proven effective for over a decade since we first adopted a global mission in 2009. Learn more about our
While our primary aim is to help hospitals provide regular, continuous fistula services, in extreme cases where conditions on the ground do not permit this, we will cover the cost of a visiting surgeon, if this is the only way women in a region can access surgery. A powerful example of this “camp” model is our work in Sudan’s Nuba Mountains, an area crippled by a severe shortage of medical professionals and brutal bombings from the country’s corrupt government.
Goal 2: Use our evidence-based countrywide treatment model to eradicate fistula country by country
Our second, longer-term goal is to eradicate the scourge of fistula globally. Fistula Foundation’s proven countrywide treatment model—with adequate backing—can end fistula in a generation on a country-by-country basis. The results of our rigorous and successful 6-year program in Kenya demonstrate that this model has the power to reach women in previously unreachable places and draw down a country’s backlog of fistula cases.
This model harnesses the power of local stakeholders to develop a strong network of well-equipped hospitals across the country. These facilities are staffed by well-trained surgeons and nurses, sharing the resources and best practices needed to provide free, year-round fistula care. We collaborate with local grassroots organizations and government agencies to provide local health workers and outreach teams with the resources they need to educate communities about fistula and refer patients to a hospital in our network. With access to more treatment centers in more places, women are no longer put on a waiting list for surgery or forced to travel long distances to receive high-quality fistula care. Our countrywide network model also helps “build the bench” by training more fistula surgeons to internationally accredited standards, and helps women build a new life after fistula with psychological counseling and economic empowerment.
Following our successful Kenya pilot, launched in 2014, we secured funding in 2017 to set up a second countrywide network in Zambia. Today both programs are thriving. We are eager to roll out this path-breaking model to new countries across Africa and Asia. Our criteria for potential new networks are that the country has a high unmet need for fistula treatment and an existing foundation of surgery providers. Within that framework, there is much work to be done.
We are committed to getting as much money as possible to our trusted partners in the field, because that’s where women’s lives are changed.
To ensure funding goes to the most respected local doctors and hospitals in Africa and Asia, Fistula Foundation issues grants on an invitation-only basis. Learn about our
Surgeons and hospitals that receive funding from Fistula Foundation are required to provide quarterly progress reports detailing their project activities and costs, surgical outcomes, and any challenges encountered. Fistula Foundation only releases funds once a partner’s report has been reviewed by our Medical Advisor and Program Development staff.
We work fast, because it helps our partners more if they receive their funding quickly. Following a few protocol procedures including Board approval and the signing of a grant agreement, we usually are able to turn around and dispense funds in a few days time if needed.
This means that if dedicated surgeons in developing countries come to us for help, we can respond immediately. For example, when Dr. Denis Mukwege, founder of the Panzi Hospital, desperately needed funds after a major donor pulled out, we could respond in a heartbeat. Panzi Hospital remains the leading treatment center for victims of sexual violence in the Congo, including surgery treatment of fistulas.
We fund projects on an invitation-only basis, and we’re constantly on the lookout. We are in frequent conversation with our international network of surgeons and partner organizations.
Fistula Foundation began as a fundraising organization for Hamlin Hospitals and is honored to have provided over $10 million USD in support of Hamlin. Today Fistula Foundation no longer solicits earmarked funds for Hamlin Hospitals, which now runs its own fundraising operations in the U.S., Hamlin Fistula USA. Hamlin Hospitals also has partner organizations in Australia, the UK, the Netherlands, Germany, Sweden, New Zealand and Japan.
Fistula Foundation arrives at an average cost for one surgery based on aggregate data from impact and financial reports received from partners we fund across Africa and Asia. Actual surgical costs vary depending on the local economies where our partners work. Costs for more complicated surgeries, such as treating dual vaginal and rectal fistula, can be greater. Learn more about the cost of care on
Yes. Click here to view our official letter stating our tax-exempt status.
Supporters in the UK and Australia can provide tax exempt gifts through the following Fistula Foundation’s The Life You Can Save web pages:
Supporters in Canada can make tax-exempt gifts through Fistula Foundation’s RC Forward web page.
Sorry, no. We understand your desire to find out more about your specific donation, but because of resource limitations, we are unable to keep photographs of each woman helped or to manage donor correspondence.
If you are making a gift online by credit card, there is an option on our donation form to dedicate your gift in someone’s honor. If you check this box and tell us the person’s email address, we’ll send them an email letting them know about your gift.
Online: You can easily make a donation online by visiting the Donate page on our website.
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Fundraising is a great way to get involved with the fight against obstetric fistula. We’ve got lots of tips and resources available on our
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A fistula is a hole.
An obstetric fistula of the kind that occurs in many developing countries is a hole between a woman’s vagina and one or more of her internal organs. This hole develops over many days of obstructed labor, when a mother is unable to access emergency maternal care. Contrary to a common misconception, this injury is not due to the ripping of tissue, rather it is due to the pressure of the baby’s head being pushed against the mother’s pelvic bone by uterine contractions during labor. This pressure can cut off the supply of oxygenated blood. Deprived of oxygen, the tissue becomes “necrotic” or dead. When this dead tissue falls away, it leaves behind holes in the vagina, bladder and sometimes the rectum. These holes result in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their foul smell.
Traumatic fistula is the result of sexual violence. The injury can occur through rape or women being butchered from the inside with bayonets, wood or even rifles. The aim of sexual violence is to destroy the women and the community within which the sufferer lives. Once committed, the survivor, her husband, children and extended family become traumatized and humiliated. Panzi Hospital in Congo is a pioneer in treating victims of traumatic fistula, and Fistula Foundation is proud to support their work. Learn more about their work on our
The Institute for Health Metrics and Evaluation (IHME) compares the burden of different health conditions through a relative-weight metric. A weight of 0 means perfect health, and a weight of 1 means death. The IHME rates Vesico-vaginal fistula (incontinence of urine) at 0.342, putting it on par with complete hearing loss and drug-resistant tuberculosis. It rates recto-vaginal fistula (incontinence of feces) at 0.501—on par with terminal cancer.
An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but cannot access to emergency medical care, such as a C-section. It is a symptom of deep, intractable poverty and the low status of women and girls.
In poor countries, many children are malnourished, which can stunt their growth. If a young mother’s pelvis is not fully mature, she is at an increased risk of experiencing an obstructed labor—and with it, devastating childbirth injuries like obstetric fistula. The practice of early marriage and young pregnancy can additionally compound this risk. Child marriage remains a worldwide issue, affecting millions of girls around the globe.
Another key cause of fistula is a critical lack of doctors and medical facilities. In poor, rural regions of Africa and Asia, fewer than 6 out of 10 women give birth with a medical professional present.
Even though obstructed labor occurs in approximately 5% of all child births worldwide, obstetric fistula has largely been eradicated in wealthy countries, thanks to the advent of the Cesarean section in the early 1900s.
Today, fistula persists in low-income countries where women have limited access to emergency obstetric care. It continues to destroy women’s lives at an alarming rate in poor, rural regions of Africa and Asia, where fewer than 6 out of 10 women give birth with a medical professional present. Learn about
Yes. An obstetric fistula can be closed with corrective surgery. If the operation is performed by a skilled surgeon, a woman with fistula can very often return to a normal life, with her continence and hope restored.
Launched in 2012 by Fistula Foundation, Direct Relief and UNFPA, the Global Fistula Map is the single most comprehensive source for understanding worldwide availability of treatment for women living with fistula. The map relies on self-reported data from treatment partners, but counts only 60,280 surgeries completed between 2012 and 2015 – about 20,000 per year.
While harmful traditional practices such as female genital cutting (FGC) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients have been victims of FGC, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGC does not “cause” a fistula.
FGC can, however, make treatment of an obstetric fistula more complicated, because the scar tissue resulting from FGC can make fistula repair surgery more difficult.
A peer-reviewed analysis, published in December 2013 by a team at the London School of Hygiene and Tropical Medicine, estimates there are over one million women suffering with obstetric fistula. Because many women with fistula sustained their injury as young women — many still in their early twenties or even late teens — they are likely to live with their condition for decades if it is left untreated. Yet surveys done for the Global Fistula Map estimate that fewer than 20,000 surgeries are performed per year.
Women are susceptible to developing fistulas in low-income countries with poor access to emergency maternal care. Today fistula remains prevalent in poor, rural regions of sub-Saharan Africa and parts of Asia. With the advent of the C-section in the early 1900s, the condition was largely eliminated in wealthy countries such as the United States.
To learn more about the regions where Fistula Foundation works, please see our
Any woman with obstructed labor who has access to competent emergency obstetric care, including a Cesarean section, will not develop a fistula.
Like obstetric fistula, a severe perineal tear is a debilitating injury that can occur when a woman in labor does not have access to adequate care.
The perineum is the area between the vagina and the rectum. It’s common for this area to tear during childbirth, though the severity of the tear varies. Most first-time mothers giving birth vaginally will have first- or second-degree tears, which are small and often heal quickly on their own, or with minor stitches.
Third- and fourth-degree tears, however, are much more debilitating. These tears are deeper and require surgery or a longer healing time. In parts of Africa and Asia, where many women lack obstetric care during deliveries, these injuries often go untreated. Third- and fourth-degree tears may include a complete tear of the anal sphincter muscle, leaving a woman incontinent in feces. The effects of the injury mirror those of the most severe form of obstetric fistula, recto-vaginal fistula.
Yes. Corrective surgery provides effective treatment for women suffering from a severe perineal tear. If the operation is performed by a skilled surgeon, a woman with this childbirth injury can very often return to a normal life, with her continence and hope restored.
Women with severe perineal tears are poor and can’t afford the cost of their treatment. Fistula Foundation supports repair surgery for women living with this debilitating childbirth injury, which severely reduces quality of life. Reported cases of these painful tears are up, and today account for 20% of all surgical cases across our partner sites.