One By One – Funding care for women with fistula

Obstetric fistula, a devastating childbirth injury, affects women and girls living in poverty in the developing world.

Without treatment, fistula sufferers will leak bodily fluids for the rest of their lives. They are then relegated, literally, to the edges of society, unable to board a bus, enter a hospital, pray communally or even share a meal with people in many cases.

Amazingly this condition can be cured for $300. One By One makes it easy to change a woman’s life and, in turn, the life of her community.

 One By One is a volunteer-led initiative in support of UNFPA’s Campaign to End Fistula. One By One enables people to make a difference by creating giving circles whereby one leader gives $30 and asks nine friends, family, coworkers or colleagues to do the same. With ten donors each giving $30, the giving circle will raise $300 – enough money to cover the cost of fistula surgery, post-operative care and rehabilitation for one woman. Learn more about the giving circle process in the One By One toolkit for giving circle leaders.
Or start a giving circle right now!

What is One By One?
One By One was started in Seattle by two women who were profoundly moved by the plight of women suffering from obstetric fistula. We are a grassroots volunteer initiative in support of the UNFPA’s (United Nations Population Fund) Campaign to End Fistula. We are under the umbrella of a 501c3 agency, the United Nations Foundation. We feel that with good minds and open hearts, fistula could simply be gone. One By One’s main goals are to spread the word and raise funds to treat and prevent fistula.

For more information about the United Nations Foundation and the Campaign to End Fistula, click here.

About the Founders

Heidi Breeze-Harris and Katya Matanovic.

About the volunteers
One By One is powered by an amazing group of volunteers. Our core team is a group of women in Seattle who do everything from represent us to corporations, to program development, to help us host events, to database work. We are grateful for all that each of these wonderful women brings to the project and we couldn’t grow and thrive without their help!


We love volunteers so let us know if you are interested in helping out! (You don’t have to live in Seattle to be a volunteer.) If you are interested in volunteering with One By One. We’ll contact you to learn what you would most like to do and then work to find a great fit between your time and energy and our project needs.

One By One’s Goal and Objectives
The goal of One By One is to support UNFPA in the global Campaign to End Fistula.

We meet this goal through the following activities and objectives:

Raising funds – $300 covers the cost of one woman’s fistula surgery, postoperative care and rehabilitation

Raising awareness – The initiative will help end the silence and stigma that surrounds fistula

Being self-sustaining – One By One is entirely powered online, through word of mouth and the energy of individuals working to create lasting change a little at a time

Connecting people to the power of their money and their generosity, with $300, (or $30 each for ten people) a giving circle can move a woman’s life experience from one of despair, isolation and ill health to one of community connectedness, functioning, and health. It is amazing what $30 and nine phone calls can do!

Imagining a world where no woman or girl suffers from obstetric fistula

What is UNFPA?
The United Nations Population Fund is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programs to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.

What is the Campaign to End Fistula?
In 2003, UNFPA and its partners launched the first-ever global Campaign to End Fistula. Its overall goal is to eradicate fistula. This includes interventions to: prevent fistula from occurring, treat women who are affected and to restore hope to those who suffer from the condition. The Campaign currently covers 35 countries in sub-Saharan Africa, South Asia and some Arab States. The Campaign works in partnership with individual hospitals, clinics, non-governmental agencies and governments to fund, implement and evaluate programs.

To read a thank you letter from UNFPA, click here.

Why does the Campaign to End Fistula receive One By One’s funds?
After one year of exhaustive research on the issue these reasons made our decision clear:

1. Long-term, Sustainable Approach
The Campaign works innovatively and collaboratively on both treatment and prevention – an important element since we want to see the problem eradicated and we want our donors to know they are making a long-term difference

2. Broad distribution of funds and assistance
The Campaign works in partnerships to ensure that 35 countries and programs are getting the help they need – this broad approach is important to us at One By One since we want women in Nigeria to get as much help as women in Uganda as women in Bangladesh etc.

3. Accountability
Each country that participates in the Campaign must complete a needs assessment, a work plan and then they are regularly evaluated based on meeting the goals of their own work plan. The Campaign itself was audited in 2003 and found to be of the highest integrity.

What is the United Nations Foundation?
The UN Foundation was created in 1998 with entrepreneur and philanthropist Ted Turner’s historic $1 billion gift to support UN causes and activities. The UN Foundation builds and implements partnerships to address the world’s most pressing problems, and also works to broaden support for the UN through advocacy and public outreach. The UN Foundation is a public charity.

How does One By One work with the UN Foundation?
The UN Foundation serves as One By One’s fiduciary umbrella. UNF also provides logistics such as administration of funds and maintenance on the technical aspects of our website. The UN Foundation, as a 501c3 agency, is able to guarantee all US donors tax deductibility for their donations through One By One. Additionally, the UN Foundation generously takes funds raised through One By One and passes those funds to the Campaign to End Fistula without taking any overhead for that administration.

How can I learn more?
On our website you will find additional detailed information such as the most recent audit and annual report from the Campaign to End Fistula along with the annual report, ratings and financial information on the United Nations Foundation.

1. What is obstetric fistula?
2. What are the medical consequences of fistula?
3. What are the social consequences of fistula?
4. Why does fistula occur?
5. Can fistula be “cured”?
6. How much does it cost to treat a fistula?

7. How widespread is fistula?
8. Where does fistula occur?
9. How can fistula be prevented?
10. What is the Campaign to End Fistula?
11. Links
12. What can I do to help?

1. What is obstetric fistula?
Obstetric fistula is an injury of childbearing that has been relatively neglected, despite the devastating impact it has on the lives of girls and women. It is usually caused by several days of obstructed labor, without timely medical intervention – typically a Caesarean section – to relieve the pressure. The consequences of fistula are often life shattering: In as high as 90 percent of fistula cases, the unborn babies will have died in the womb and been stillborn. The women are left with chronic incontinence. Because of the inability to control their flow of urine or feces, they are often abandoned or neglected by their husbands and families and ostracized by their communities. Without treatment, prospects for work and family life for these women are greatly diminished, and they are often left to rely on charity.

2. What are the medical consequences of fistula?
Left untreated, fistula can lead to frequent ulcerations and infections, kidney disease and even death. Some women drink as little as possible to avoid leakage and become dehydrated. Damage to the nerves in the legs leaves some women with fistula unable to walk, and after treatment they may need extensive physical rehabilitation. These medical
consequences, coupled with social and economic problems, often contribute to a general decline in health and well being that can result in early death. However, many women with fistula are strong – as demonstrated by their having survived prolonged, traumatic
labor – and they can live a long time.

3. What are the social consequences of fistula?
Beyond these physical consequences, fistula often exacts a severe social toll. The social consequences of fistula include physical and emotional isolation, abandonment or divorce, ridicule and shame, infertility, lack of economic support, and the risk of violence and abuse.

4. Why does fistula occur?
Fistula occurs when emergency obstetric care is not available to women who develop complications during childbirth. This is why women living in remote rural areas with little access to medical care are at risk. Before the medical advances of the 20th century, fistula was quite common in Europe and the United States. Today, fistula is almost unheard of
in high-income countries, or in countries where obstetric care is widely available. Fistula tells us where health systems are failing. The World Health Organization has called fistula “the single most dramatic aftermath of neglected childbirth.” Malnutrition, poor health services, early marriage and gender discrimination are interlinked root causes of obstetric
fistula. Poverty is the main underlying factor, as it is associated with early marriage and malnutrition, and because lack of funds hinders a woman’s access to emergency obstetric care. Consequently, young and poor women living in rural areas are particularly at risk.
Because of their low status in many communities, women often lack the power to choose when to start bearing children or where to give birth.

Childbearing before the pelvis is fully developed, as well as malnutrition, small stature and generally poor health, are contributing physiological factors to obstructed labor. Older women who have delivered many children are at risk as well.

5. Can fistula be “cured”?
Yes, fistula is treatable as well as preventable. Reconstructive surgery can mend the injury, and success rates are as high as 90 percent for uncomplicated cases. (For complicated cases, the success rate is closer to 60 percent.) Two weeks or more of post-operative care is needed to ensure a successful outcome. Counselling and support are also important to address emotional damage and facilitate social reintegration. The average cost of fistula treatment – including surgery, post-operative care and rehabilitation support – is $300.

6. How much does it cost to treat a fistula?
UNFPA has estimated that the average cost of fistula treatment – including surgery, post-operative care and rehabilitation support – is $300.

7. How widespread is fistula?
Fistula is most common in poor communities in sub-Saharan Africa and parts of Asia where access to or use of obstetric care is limited. Good data on fistula are scarce. In 1989, the World Health Organization estimated that more than two million women remain untreated
in developing countries and that at least 50,000 to 100,000 new cases occur each year. But the secrecy and shame that surround the condition make it difficult to get a reliable estimate of its prevalence. Needs assessments done as part of the Campaign to End Fistula suggest those numbers are far too low. In fact, WHO experts have also estimated that in areas of high maternal mortality, two to three women per 1,000 pregnancies develop
fistula, which would mean that the prevalence is likely much higher than the 1989 estimates.


8. Where does fistula occur?
Fistula is most common in poor communities in sub-Saharan Africa, South Asia and some Arab states. The Campaign is active in the following countries:
Africa: Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Democratic Republic of Congo, Equatorial Guinea, Eritrea, Ghana, Kenya, Malawi, Mali,
Mauritania, Mozambique, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Africa, Tanzania, Togo, Uganda, Zambia
Asia: Bangladesh, India, Nepal, Pakistan
Arab States: Djibouti, Somalia, Sudan, Yemen


9. How can fistula be prevented?
Prevention, rather than treatment, is the key to ending fistula. Making family planning available to all who want to use it would reduce maternal disability and death by at least 20 percent. Complementing that with skilled attendance at all births and emergency obstetric care for those women who develop complications during delivery would make fistula less common. These interventions are part of UNFPA’s overall strategy to make motherhood safer. Addressing social issues that contribute to the problem – such as early pregnancy,
girls’ education, poverty and women’s empowerment – are important areas of intervention as well.


10. What is the Campaign to End Fistula?
The United Nations Population Fund, (UNFPA) is the world's largest international source of funding for population and reproductive health programs. UNFPA supports programs in
over 140 developing countries to improve reproductive health by supporting men, women and youth to plan their families, undergo pregnancy and childbirth safely, prevent HIV/AIDS, and ensure women’s equality. In 2003, UNFPA and its partners launched the first-ever global Campaign to End Fistula. This includes interventions to:
• Prevent fistula from occurring.
• Treat women who are affected.
• Renew the hopes and dreams of those who suffer from the condition.

This includes bringing it to the attention of policy-makers and communities, thereby reducing the stigma associated with it, and helping women who have undergone treatment return to full and productive lives.
The Campaign currently covers more than 30 countries in sub-Saharan Africa, South Asia and some Arab States. In each country, the Campaign proceeds in three phases:
• First, needs assessments are undertaken to determine the extent of the problem and the resources to treat fistula.
• Second, each country that completes a needs assessment receives financial support for
planning, including raising awareness of the issue, developing appropriate national strategies and building capacity.
• Finally, a multi-year implementation phase begins, which includes interventions to prevent and treat fistula, such as improving obstetric care; training health providers; creating or expanding and equipping fistula treatment centers; and helping women reintegrate into
their communities.

Below you will find additional detailed information such as the most recent audit of the Campaign, the annual reports from both the UN Foundation, and the Campaign to End Fistula.

The Campaign to End Fistula
Annual Report 2004

Financial report and audited financial statements for the biennium ended 31 December 2003 and Report of the Board of Auditors
United Nations Population Fund

United Nations Foundation Overview


11. What can I do to help?
One of the most powerful ways you can help is to donate to this cause. Most of the maternal deaths and disability due to childbirth can be prevented, and the cycle of poverty that results from women and girls suffering from fistula can be stopped. Resources are the key to providing services and education in the field. One By One has made it easy to spread the word, do some simple fundraising and be an ambassador. We are constantly developing new ways for people to get involved so if you are interested or would like to share your particular story or skills with us, email us at