Why Do We Work in Madagascar?

The island of Madagascar is home to some of the most diverse plant and animal life in the world. But its people face extreme poverty—three-quarters of the population live on less than $1.25 per day. And in a country of over 24 million people, there are not enough doctors or health facilities to sufficiently meet the needs for maternal health care.

In Madagascar, one in 60 women will die in childbirth during their lifetime. The fertility rate is high, and there is also a high rate of teenage pregnancy—more than one-third of girls ages 15-19 have had children or are currently pregnant. When these factors are combined with the prevalence of grinding poverty, it is likely that obstetric fistula is a serious issue in Madagascar.

What You Help Us Do in Madagascar

We’re helping fund:

  • Fistula surgeries
  • Surgeon training
  • Community outreach


Hopitaly Vaovao Mahafaly, Mandritsara
SALFA Antanimalandy
SALFA Morondava
SALFA Vangaindrano
Fistula Care Center at Centre Hospitalier Universitaire Toamasina (CHUT), Toamasina

How much funding have we granted?

$99,500 in FY2012 (divided between projects in Madagascar, Malawi, and Mauritania)

Hopitaly Vaovao Mahafaly

$6,500 in FY2016


$207,500 in FY2017
$75,000 in FY2016

Freedom from Fistula

$179,473 in FY2016

Who are our partners?

We currently provide grant support directly to SALFA and Freedom from Fistula. In the past, we provided grant support to several hospitals through Operation Fistula.

How will this help women in Madagascar?

Sampan’Asa Loterana momba ny Fahasalamana (SALFA) is the health department of the Malagasy Lutheran Church. Coordinating the activities of 10 hospitals, nearly 20 urban dispensaries, and 15 rural health clinics, they cover 21 out of 22 regions of the island, one of the most geographically challenging countries on Earth. Six of SALFA’s 10 hospitals provide routine fistula treatment. With several qualified fistula surgeons, SALFA has been successfully providing some fistula surgeries over the last two years. In 2016, funding from Fistula Foundation supported treatment for 100 women, and also funded lodging, meals, and transportation for each patient and one family member, allowing them to travel to and from the hospital for surgery and for a separate follow-up appointment.

Our partner Freedom from Fistula has supported fistula treatment in Madagascar since 2014, through a partnership with Mercy Ships, a traveling charitable hospital providing free medical care to African coastal regions. In late 2016, Freedom from Fistula established a permanent Fistula Care Center in Madagascar at the Centre Hospitalier Universitaire Toamasina (CHUT), a hospital on the island’s east coast. Funding from Fistula Foundation will cover the cost of surgery for 100 women at the new center, as well as pre- and postoperative care.

Through our partner Operation Fistula, a two-week fistula clinic was organized in August 2013, and a percentage of these surgeries were funded by Fistula Foundation. The clinic was held in southeastern Madagascar, as this is an area known to have a high prevalence of fistula based on a survey conducted by UNFPA. It included operations from both local and internationally renowned fistula surgeons, the former of which continued to provide obstetric fistula repair surgery throughout the year at their own hospitals under this grant.

Where is Madagascar?

Facts About Madagascar

  • Population:24,430,325
  • Average births per woman:4.12
  • Physicians per 10,000 people:1.6
  • Births attended by skilled personnel:44.3%
  • Lifetime risk of maternal death:1 in 60(chances a woman will die during childbirth)
  • Female life expectancy:66.67 years
  • Female literacy:62.6%
  • Population living in rural areas:64.8%
  • Population living in poverty:75.3%(less than $1.25/day)
  • Surgeries completed through Fistula Foundation funding to date:195

Sources: CIA World Factbook; WHO; World Bank

We’re Making a Difference in Madagascar

Field Notes: On the road in Madagascar

By Bill Mann, Fistula Foundation Board Chair I’m going to introduce you to Vavizely in a second. I warn you, her story is fairly difficult to imagine and a little hard to take. I met Vavizely at Freedom from Fistula’s surgical center in Toamasina, Madagascar. Toamasina is a compact, neat, prosperous coastal town, the commercial…

Spotlight on Where You’re Helping: Madagascar

Despite being known for its rich biodiversity, Madagascar’s people face extreme poverty—three-quarters of the population live on less than $1.25 per day. Fertility rates are high, and child marriage is prevalent in poor, rural areas. Many women lack access to skilled health care providers during delivery, significantly increasing the risk of childbirth complications like fistula….