Volume 108

Justice for Women and Society: The Case of Obstetric Fistula

by Jennifer Prah Ruger, Kara Zhang & Esther Nivasch Turner

Obstetric fistula, a preventable childbirth injury, afflicts 2–3 million women worldwide. Obstetric complications of obstructed labor, such as when cephalo-pelvic disproportions prevent the baby from exiting the birth canal, can lead to abnormal tracts forming between the vagina and the rectum or bladder. Whereas 50,000–100,000 new cases develop in low- and middle-income countries annually, obstetric fistula has been eliminated since the late nineteenth and early twentieth centuries in high-income countries through standardizing health-provider training, increasing access to obstetric care, and improving surgical techniques. Over the past twenty-five years, human rights efforts—for example, the United Nations’ Millennium Development Goals on maternal health and Campaign to End Fistula—have emerged as the prevailing international approach to reducing maternal morbidity and mortality. This Article advances a unified theory of justice and health, grounded in the health capability paradigm at the domestic level, provincial globalism at the global level, and shared health governance as a theoretical foundation for maternal health policy and specifically as a standard and guide for obstetric fistula. At the same time, this Article critically examines current approaches, including human rights, international law, and bioethical principlism, identifying normative, conceptual, and practical challenges with these movements.

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