Effective Altruism
What is effective altruism?

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. Named after Singer’s seminal book, The Life You Can Save organization is one of the nonprofit sector’s most authoritative voices on Effective Altruism. Since 2014, The Life You Can Save has recommended Fistula Foundation as one of its Top Charities that it believes provides the greatest good for funds spent.

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 $619.
  • The Institute for Health Metrics and Evaluation rates the health burden of vesico-vaginal fistula (incontinence of urine) on par with complete hearing loss and drug-resistant tuberculosis. It rates recto-vaginal fistula (incontinence of feces) on par with terminal cancer.
  • Empowerment starts with a woman’s ability to work. For the women that Fistula Foundation is in business to treat, their injury – obstetric fistula – leaves them unable to contribute to their communities and families. 
  • Fistula most commonly occurs to women in their twenties, in countries where the average life span is approximately 65 years—meaning a one-time surgical intervention can restore 40+ years of health.

Background resources


How We Work
How does Fistula Foundation make sure my donation is used as intended?

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 partner selection process

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.

How much does it cost to treat obstetric fistula?

The average cost per patient is $619 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 Our Strategy page

How do you determine the $619 USD cost for fistula repair surgery?

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 Our Strategy page

What type of projects does Fistula Foundation fund?

We are committed to helping women with fistula and untreated tears, 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 these conditions 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 and tear repair surgery, we strengthen the efforts of these local experts, equip hospitals to provide high-quality 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 Investment Areas

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 untreated fistula and severe perineal tear 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.




Why don’t you focus on prevention?

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 Our Strategy

How does Fistula Foundation choose its partners?

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 the International Federation of Gynecology and Obstetrics (FIGO), 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 60 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.

How do you find out about new funding opportunities?

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.

How long does it take for a partner to receive funding?

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 turn around and dispense funds in about 2 months, though we can, and do. respond quickly to emergencies 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 surgical treatment of fistulas.

How did Fistula Foundation start?

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 33 countries at sites on two continents, Africa and Asia. We fund more obstetric fistula surgeries globally than any other organization.

Does Fistula Foundation provide funding for the Hamlin Fistula Hospitals in Ethiopia?

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.

Making a Gift
What type of donations does Fistula Foundation accept?

There are many ways to make a gift to Fistula Foundation. No matter how you give, you’re helping support a mission that transforms the lives of women suffering with obstetric fistula.

Online, Phone, and Mail: Donate when and where it’s convenient for you.

  • Make a secure gift online. Donate now 
  • Call us: 408-249-9596
  • Mail your donation to:
    Fistula Foundation
    1700 The Alameda, Suite 300
    San Jose, CA 95126

Other Ways to Give

  • Cryptocurrency: You can make a secure donation through our crypto partner, the Giving Block. See Cryptocurrency Donation
  • Donor-advised Fund: You can directly recommend grants from your donor-advised fund using DAF Direct, a free and secure web payment platform. See DAF Gift
  • Fundraise for Us: Use our toolkit to spread the word or set up your own personal fundraising page. See toolkit
  • International Donors: We offer tax-deductible giving options for donors in Australia and the U.K. Make an international gift
  • Love a Sister: Directly fund one woman’s surgery with a single donation of $619 or a monthly donation of about $52. Support one woman’s surgery
  • Matching Gifts: Double your impact with a matching gift from your employer. See Employer Match
  • Monthly Giving: Join our dedicated group of monthly supporters committed to making a difference. Sign up for monthly giving
  • Planned Giving: Choosing to include Fistula Foundation in your estate planning is a selfless act of generosity. See Planned Giving
  • Stock Gift: We’re able to accept donations of appreciated securities through the Depository Trust Company (DTC). See Stock Gift
Where can I mail my donation?

You can send your personal checks, cashier’s checks, or money orders, made payable to Fistula Foundation, to the address below:

Fistula Foundation
1700 The Alameda, Suite 300
San Jose, CA 95126

If you have any further questions, staff are available to take your call Monday – Friday, 9am to 5pm Pacific. Please call our office at:

What is Fistula Foundation's tax ID number?

Fistula Foundation’s U.S. Tax Identification Number is 77-0547201.

For further inquiries, please contact Jackelen Renteria-Bustos, Marketing and Communications Associate, by email (jackelen@fistulafoundation.org) or phone (408-249-9596).

How can I update my existing monthly donation?
  • If you need to update your credit card information or the amount of your monthly gift, you can do so by creating a new subscription— we’ll take care of removing the old information.  
  • Or please call our office at 408-249-9596, and we will handle the changes on our end.
Are my donations to Fistula Foundation tax deductible?

Absolutely! Fistula Foundation is a registered 501(c)3 in the United States. 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:



How can I donate in honor of someone?

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.  We will only use the email provided to notify the person of your gift.

I am a Financial Adviser and am looking for information.

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.
  • To send gifts of securities and/or arrange wire transfer gifts, or if you are an executor or an attorney representing an estate: please contact Donalda Watson-Walkinshaw, Director of Fundraising Operations, by email (donalda@fistulafoundation.org) or phone (408-249-9596).
I would like to host a fundraiser. What resources are available?

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 How to Help page

For more information about hosting a fundraiser, please contact Jackelen Renteria-Bustos, Marketing and Communications Associate, by email (jackelen@fistulafoundation.org) or phone (408-249-9596).

Is there any way I can have a photo or stay in touch with the woman I have assisted?

While we understand your desire to find out more about your specific donation, we are limited in resources and are unable to keep photographs of each woman who have received surgery.

If you’d like to learn more about the impact of your gift, please reach out to Jackelen Renteria-Bustos, Marketing and Communications Associate, by email (jackelen@fistulafoundation.org) or phone (408-249-9596).


Is my information secure when I submit it on your website?

We are committed to providing you a safe means of communicating your sensitive information. Our website complies with industry standards for Secure Sockets Layer (SSL) data encryption to ensure your personal data is safely and securely transmitted across the web.

We do not share your contact information. See Privacy policy

Do you accept cryptocurrency?

You can make a secure, tax-deductible crypto donation using our Crypto Donation Utility. Visit our Cryptocurrency webpage for additional details and to get started.

Through our partnership with The Giving Block, we’re able to accept over 50 cryptocurrencies, with more being added regularly. You can see the current list on the widget’s drop down menu under “Other crypto options.” Some of the currencies we accept include:

  • Amp (AMP)
  • Bitcoin (BTC)
  • Ether (ETH)
  • Litecoin (LTC)
  • Bitcoin Cash (BCH)
  • Zcash (ZEC)
  • Gemini Dollar (GUSD)
  • Basic Attention Token (BAT)
  • Chainlink (LINK)
  • Dai (DAI)
  • Storj (STORJ)
  • UMA (UMA)
  • 0x (ZRX)


Obstetric Fistula
What is a fistula?

A fistula is a hole. 

An obstetric fistula 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 DRC country page

An iatrogenic fistula is caused unintentionally by a healthcare provider. For example, the bladder may be accidentally cut during a C-section or hysterectomy, resulting in a hole through which urine leaks. Iatrogenic fistulas are becoming more common in places where women deliver in a health facility but where the health workers do not have the skill to provide high quality care. These cases currently comprise 11% of fistula we treat and underscore why supporting training and well-equipped facilities are so essential. Learn more about our investment areas

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.

Can obstetric fistula be cured?

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.

What are the root causes of fistula?

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but cannot access 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.

Does obstetric fistula occur in wealthy countries?

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 where we work

Where is fistula prevalent?

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 Country Directory

How many women does this problem affect?

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.

Can obstetric fistula be prevented?

Any woman with obstructed labor who has access to competent emergency obstetric care, including a Cesarean section, will not develop a fistula.

I heard that fistulas are a result of female genital cutting. Is this true?

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.

Severe Perineal Tears
Can perineal tears be treated?

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 untreated 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.  


What is a perineal tear?

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. 




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