Obstetric Fistula and Justice for Women
Obstetric fistula is a preventable childbirth-related injury that affects two to three million women worldwide. It disproportionately impacts low- and middle-income countries, with 50,000 to 100,000 new annual cases. High-income countries eliminated obstetric fistula in the late nineteenth and early twentieth century by standardizing health provider training, increased access to obstetric care, and improving surgical techniques.
We analyzed this problem under a unified theory of justice and health, including Shared Health Governance, which provided a theoretical foundation for maternal health policy and a standard and a guide for obstetric fistula. It is a framework both for domestic and global level policy formation.
In analyzing obstetric fistula, SHG was used as a standard to evaluate current practices and offer solutions forward. The theory stresses the alignment of individual and group interest towards a common good with shared goals, including eradicating obstetric fistula. Its emphasis on the formation of public moral norms and incompletely theorized agreements ensure that the obstetric fistula policies are substantively and procedurally legitimate (i.e., its content is acceptable in the standard of the common good, and the process of policy formation includes every actor, unlike the current global health landscape granting the decision-making ability to the financially and politically powerful).
SHG assigns countries the primary responsibility to meet their domestic health objectives, including eradicating obstetric fistula. It supplements such a responsibility allocation with an effective role assignment to other parties (individuals, governments, private entities) based on what justice for women requires. It emphasizes shared individual and social responsibility, effective and efficient coordination of actors, governance for the public health common good, and the recognition of shared identity creating shared norms, values, and goals.