As EngenderHealth, a non-profit organization based in the United States,
explains, “[t]he journey toward obstetric fistula begins with poverty . . .
Poverty robs people of choices. It contributes to fistula by closing off options
at critical points in a woman’s life.”101 Instances of these “closing off
options” include forced marriage and denial of reproductive autonomy.102
Disempowered, these girls must rely on their parents, fathers and mothers
whose ideas about marriage and reproduction are often at variance with their
interests.103 UNICEF notes, “these parents encourage the marriage of their
daughters while they are still children in hopes that the marriage will benefit
them both financially and socially, while also relieving financial burdens on
the family.”104 In these bizarre dynamics, early marriage (and with it, the risk
of fistula) becomes a poverty alleviation measure, but – quite often – with
Margaret Mungherera, in her inaugural address as the president-elect of
the World Medical Association, was echoing the spirit of the Millennium
Declaration by provocatively stating: “[ i]f you miss the poor, you’ve missed
the point.”105 The Millennium Declaration affirms an obligation incumbent
upon the international community to “promote gender equality and the
empowerment of women as effective ways to combat poverty, hunger and
disease and to stimulate development that is truly sustainable.”106 Indeed, the
point of the Declaration was poverty and its impact on human development,
explaining why the very first of the MDGs was specifically targeted at
poverty eradication.107 This premier positioning is not happenstance. It
recognizes that the rest of the MDGs are not attainable in absence of
resources with which individuals are able to pursue their individual goals.
Amongst its major objectives is ensuring that even those without resources –
impoverished girls and women struggling against the pain, shame and misery
of fistula – are not without hope.108 This, as the next section demonstrates, is
101. Emily Verellen, A Walk to Beautiful: Take Action Guide, EngenderHealth (2014),
104. Early Marriage: A Harmful Traditional Practice, UNICEF 1 (2005), http://
105. Jane Parry, The Disease of Poverty is Doctor’s Business Everywhere, BMJ BLOGS
(Oct. 24, 2013), http://blogs.bmj.com/bmj/2013/10/24/jane-parry-the-disease-of-poverty-is-a-
106. G. A. Res. 55/2, ¶ 20, United Nations Millennium Declaration, 5 (September 18,
2000) [hereinafter Millennium Declaration], http://www.un.org/ga/search/view_doc.asp?
107. U.N., supra note 52, at 5.
108. See generally Sustainable Development Goals, UNITED NATIONS DEV.