(a) prevention (of the conditions or circumstances that contribute to fistula);
(b) improving access to maternal health, including obstetric care and
availability of skilled health personnel (SHP) to handle deliveries; (c)
addressing early pregnancy/marriage; (d) improving access to education for
girls; (e) promoting women empowerment; and, (f) eliminating poverty. 20
These, apparently, are crucial interventions and strategies with positively
transformative impact in countries with significant fistula populations,
assuming responsible authorities in those countries take them seriously.
Strikingly, each of these measures is integrated into one or more of the
MDGs. 21 It is this integration that lends credence to extant belief that the
world is close, perhaps more than ever before, to consigning fistula to
The MDGs consist of eight time-bound and quantifiable targets aimed at
improving human wellbeing, with 2015 as the deadline for achieving most of
them. 22 The benchmarks of the vast majority of the MDGs are closely
related, as previously mentioned, to the measures identified by UNFPA as
crucial to arresting fistula. But whether this hope will morph into reality
depends on whether the obligations associated with each of the MDGs are
taken seriously by political leadership in affected countries. The rest of this
section considers these MDGs and their bearing on fistula.
Multiple reasons underscore the importance of the maxim “prevention is
better than cure” in the realm of public health. 23 Aside from cost saving,
taking action that shields oneself from diseases and illnesses protects the
individual from the pain, suffering and, possibly, death that could have been
the end result of inaction. 24 Nevertheless, reaping the benefit of preemptive
action is primarily dependent on the level of knowledge or awareness of the
individual of necessary preventive measures – in other words, success is
relative to the individual’s academic attainment. 25 To illustrate how this
relates to fistula, we travel all the way to Niger, a country ranked dead last in
the latest human development index. 26 This is a real life event, as reported in
21.MD GS: What They Are, UNITED NATIONS MILLENNIUM PROJECT, http://www.
unmillenniumproject.org/goals/index.htm (last visited Oct. 10, 2015).
23. E.g., Stephen J. Genuis, An Ounce of Prevention: A Pound of Cure for an Ailing
Health System, 53 CAN. FAM. PHYSICIAN 597 (2007).
24. See generally Rama K. Jayanti & Alvin C. Burns, The Antecedents of Preventative
Health Care Behavior: An Empirical Study, 26 J. OF THE ACAD. OF MKTG. SCI. 6 (1998).