Explanation of Position on a Resolution on Obstetric Fistula

Jason Mack
Counselor for Economic and Social Affairs
U.S. Mission to the United Nations
New York, New York
November 16, 2020


We thank Senegal and the Africa Group for their resolution on intensification of efforts to end obstetric fistula.

Untreated fistula can have a devastating impact on women’s lives due to a wide range of physical, psychological, and socio-economic consequences. Fistula can be prevented and successfully treated and survivors, who have often been ostracized, can be reintegrated into their communities. The U.S. government has invested more than $100 million to support fistula patients since 2004, restoring dignity to women’s lives and strengthening fistula prevention. To date, U.S.-funded projects have supported approximately 55,000 fistula repairs. The United States recognizes the importance of this resolution in global efforts to address this ongoing challenge.

We regret that the first amendment did not pass, and accordingly health related wording that is problematic for us remains in the resolution. The United States therefore disassociates from Preambular Paragraph 9, Operative Paragraph 2, and Operative Paragraph 3. “Sexual and reproductive health,” “health-care services,” and “sexual and reproductive health-care services” are controversial terms which detracts from the resolution’s recommendations to address obstetric fistula. These terms have accumulated connotations that suggest the promotion of abortion or a right to abortion that are unacceptable to our Administration.

The United States is committed to improving women’s health across her lifespan. However, we cannot accept references to “sexual and reproductive health, “sexual and reproductive health-care services,” “safe termination of pregnancy” or any similar language that would promote abortion or suggest inaccurately a right to abortion. As affirmed in the Geneva Consensus Declaration by countries representing every region of the globe, each nation has the sovereign right to implement related programs and activities consistent with their laws and policies, without external pressure or interference. Further, consistent with the 1994 International Conference on Population and Development Program of Action and its report, we do not recognize abortion as a method of family planning and there is no international right to abortion. We fully support the provision of quality health care to women and girls around the world without promoting abortion.

In OP 3, which refers to “the outcomes of relevant United Nations conferences and resolutions of the General Assembly outcome documents of their review conferences,” we would have preferred that clause end with “as adopted by the General Assembly.” This addition would make clear that documents adopted by member state consensus carry more weight than documents which do not enjoy such consensus.

We regret the second U.S. amendment did not pass. The U.S. government is a partner in the Global Campaign and recognizes the important activities it conducts including fistula treatment, training, and care. In regard to the references to the UNFPA and WHO, we would have preferred that the text refer to all partners rather than singling out specific organizations within the much broader campaign.

With regard to this resolution’s references to international law and the 2030 Agenda for Sustainable Development, we addressed our concerns in a U.S. statement delivered on November 13.

The United States supports the goal of having women and girls receive quality education. We note however that there is no “right to education of good quality,” as the resolution mentions, and also note that in the United States, decisions regarding curricular and other education policies, materials, and programs are made as appropriate and consistent with our respective federal, state, or local authorities.

In addition, while the resolution refers to an “internationally agreed goal of improving maternal health,” there is no binding obligation in this regard under international law. The United States, nonetheless, is firmly committed to maternal health, and our significant efforts around the globe contribute to the shared global goals for maternal and child survival.

The United States is the largest bilateral donor of foreign assistance, including promoting and protecting women’s health across their lifespan. These include equal access to holistic and optimal health care for women and girls. Support and funding for women’s health initiatives are inclusive of, but not limited to, needs related to maternal health; voluntary and informed family planning; the prevention and treatment of HIV and the prevention of the human papillomavirus (HPV); and expanded access and knowledge building to reach the highest attainable standard of health.