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, 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.
Obstetric fistula is one of humanity’s most disabling injuries, but it can be cured by a surgery that costs $586. From a health metrics standpoint, healing a woman with fistula is a highly effective intervention—comparing favorably with vaccines and bed nets.
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. Learn more about
- 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
One way of measuring the high impact of fistula surgery is through the lens of “quality-adjusted life-years.” Known as QALYs, this metric considers both the quality and the quantity of life saved through a health intervention. Fistula’s QALY measurement proves that fistula repair surgery is a highly effective investment in women’s health.
For example, by healing a woman who is leaking urine uncontrollably due to fistula, you can give her an estimated 14 QALYs—14 years of improved life. Healing a woman who is leaking feces due to fistula gives her an estimated 21 QALYs—21 years of improved life. This means fistula surgery costs only $28-$42 per year of improved life.
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.
Wherever possible, we work to empower dedicated local doctors in developing countries. In addition to paying for the direct cost of surgeries, we fund activities that remove critical bottlenecks to treatment. These include the training of surgeons, the building of hospitals and operating rooms dedicated to fistula surgery, community outreach to let women know where they can get treated, and “mobile” fistula clinics to provide treatment in rural areas where no hospitals exist.
We also fund solutions targeted to the specific needs of a partner. For example, in Senegal, we funded a fleet of motorcycle ambulances to transport patients to care facilities over difficult terrain, while in Uganda, we funded the construction of a water tank to secure a source of clean water for surgery and recovery.
Learn more about our
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.
The good news is that we continue to grow stronger each year. 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.
While the bulk of our funding is to pay for fistula surgeries, facilities and equipment, and training for doctors to perform fistula surgeries, we are funding an increasing number of cutting-edge projects.
We think entrepreneurial solutions are a good thing. When our grantees approach us with creative solutions, we listen. For example, in 2010 our grantee Women and Health Alliance International (WAHA) proposed a truly unique intervention solution to us. It was such a good idea, we offered to fund it. WAHA has designed a one-of-a-kind, three-wheeled All Terrain Ambulance Vehicle equipped to transport patients where no paved roads exist. If an emergency arises, this unique All Terrain Ambulance Vehicle can be called by radio to rapidly deliver one patient to the nearest health centre or hospital. The first was delivered in 2010 to Senegal’s Kedougou region. Hundreds more have since been commissioned and distributed throughout Africa since.
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
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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If you do not want to update your information online, or have a question about your gift, please call our offices at (866) 756-3700 (toll free in the USA) or +1 (408) 249-9596, and we would be happy to help you in person. Or you may send an email to email@example.com
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
Fistula Foundation welcomes inquiries from professional advisers. We are eager to help you assist your clients in fulfilling their philanthropic plans.
Fistula Foundation’s U.S. Tax Identification Number is 77-0547201.
Sending Gifts of Securities and/or Arranging Wire Transfer Gifts:
- Please contact Kimberly Adinolfi, Senior Development Manager for Fistula Foundation at firstname.lastname@example.org or (408) 249-9596.
If you are an executor or an attorney representing an estate, please contact Robyn Leslie, Director of Philanthropy at or (408) 249-9596.
Bequest Language: To name Fistula Foundation in your client’s will or trust, you can include the following bequest language:
- I give and devise to Fistula Foundation, a not-for-profit institution organized under the laws of the State of California, having its principal offices at 1922 The Alameda, Suite 302, San Jose, CA 95126-1430 (U.S. Tax Identification Number 77-0547201), the sum of $_____________ (or state percentage of identified assets available for distribution) to be held, managed and distributed by Fistula Foundation, at the discretion of the Chief Executive Officer, to help women suffering with obstetric fistula.
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 ripping and tearing 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, and the tissue, deprived of oxygen 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.
Fistula 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, when a girl’s body is not fully grown, also increases her risk of fistula. Child marriage remains a worldwide issue, affecting millions of girls around the globe. Too often these early marriages happen without a girl’s consent, and deprive her of the chance to continue her education. Early marriage and teenage pregnancy can result in childbirth injuries, such as obstetric fistula, or worse: the biggest cause of death in 15 – 18 year old girls is childbirth.
Another key cause of fistula is a critical lack of doctors and medical facilities. Over half of the countries in sub-Saharan Africa do not meet the minimum WHO ‘Health for All’ standard for an acceptable doctor to population ratio, which is set at one doctor per 5000 individuals. By comparison, the US has 12 doctors per 5,000 people.
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
Obstetric fistula can largely be avoided by delaying the age of first pregnancy, by the cessation of harmful traditional practices such as child marriages, and by timely access to quality obstetric care. Any woman with obstructed labor who has access to competent emergency obstetric care, including a Cesarean section, will not develop a fistula.