offensiveness, often spurned by their husbands, homeless, unemployable
except in the fields, they endure, they exist, without hope . . .”
Dr. Katherine Hamlin, Second Fistulae Hospital, Addis Ababa, Ethiopia.
Is fistula a neglected disease? The theme of a conference held in Pakistan
in 2011—“No more neglected. Dignity restored.”184—as well as a number of
declarations by reputable global institutions such as the UNFPA (“Neglected
No More”)185 and the mass media (“No Longer a Neglected Tragedy”)186
suggest a negative response. Yet, whilst it is arguable that at no point in time
had fistula garnered greater global attention than now, the level of attention
remains grossly inadequate to deal with a menace that continues to wreak
havoc in the lives of 50,000–100,000 women annually.187 Andrew Browning
should know. The Australian-born obstetrician and gynecologist has spent
more than a decade of his professional life treating fistula patients in some of
the most remote and impoverished settings in the world.188 Perhaps out of
frustration with the status quo, Browning writes: “At the world’s current
capacity for dealing with the problem, it would take up to 400 years to treat
the backlog of patients. Clearly we need many more centres equipped to care
for women with fistula.”189
Translation: more is needed. As was made very clear in the abstract of this
paper, not only are the causes of fistula not shrouded in mystery, the solutions
are well known, a theme pursued in considerable detail in Part II. More
recently, The Campaign to End Fistula, an innovation of the UNFPA, has
advanced a 3-pronged strategy for dealing with the condition: (a) adopt
preventive measures, (b) treat women and girls who are affected, and (c)
support women and girls after surgery.190 Of all these strategies, the UNFPA
projects the “key to ending fistula,” is having in place a strategy or structure
that would “prevent it from happening in the first place.”191 As to what a
preventive strategy entails in this context, the agency holds that it requires
“tackling underlying social and economic inequities through initiatives
aimed at educating and empowering women and girls, enhancing their life
184. Pakistan: March 2011, A Conference to Raise Awareness About Fistula, WOMEN &
HEALTH ALLIANCE INT’L (Mar. 8, 2011), http://www.waha-international.org/?what-we-do=
185. See Neglected No More: Fighting Fistula, supra note 70.
186. See generally Grant, supra note 13.
187. When Childbirth Harms: Obstetric Fistula, supra note 4, at 3.
188. See Dr. Andrew Browning, BARBARA MAY FOUND., http://www.
barbaramayfoundation.com/dr-andrew-browning (last visited Nov. 5, 2015).
189. Andrew Browning, Obstetric Fistula in Ilorin, Nigeria, 1 PLOS MED 22, 24 (2004),
available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.
0010002; see also M. A. Ijaiya & P. A. Aboyeji, Obstetric Urogenital Fistula: The Ilorin
Experience, Nigeria, 23 W. AFR. J. MED. 7, 7 (2004).
190. Neglected No More: Fighting Fistula, supra note 70.