February 2026 Cassandra Unchained Charity of the Month

Fistula Foundation

Fistula Foundation has provided tens of thousands of needed surgeries to women across poor, rural areas of Sub-Saharan Africa and South Asia who suffer severe incontinence and discomfort as a result of significant pelvic floor injuries during childbirth.

Fistula Foundation is on a mission not only to treat these injuries but to end them altogether, to completely solve the problem.

Years ago, my wife and I were profoundly saddened to hear of the desperate plight of these women.

We remained donors for a number of years, but for some reason I cannot recall, we lost touch. While considering a charity for this month of February, the Foundation popped up, and I wondered what they were up to.

Boy, was I shocked! Fistula Foundation has grown tremendously, and by grown, I mean more than 100,000 surgeries since 2009.

Many people might not know what an obstetric fistula is, or even a severe perineal tear. These are debilitating injuries with significant social stigma and ostracization. I quote from the Foundation’s web site:

How Fistula Occurs

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but doesn’t have access to emergency medical care, such as a C-section. She often labors in excruciating pain for days. Tragically, her baby usually dies.

During her prolonged labor, the mother’s contractions continually push the baby’s head against her pelvis. Soft tissues caught between the baby’s head and her pelvic bone become compressed, restricting the normal flow of blood.

Without adequate blood supply, sections of tissue soon die, leaving holes—known as “fistulae” —between the mother’s vagina and her bladder or rectum. It is these holes that cause incontinence. If untreated, the woman will uncontrollably leak urine, stool, or sometimes both, for the rest of her life.

Under these circumstances, a woman with a fistula or a severe tear faces devastating physical and psychological consequences. Unable to control the leaking of her body’s waste, she suffers with chronic infections and pain. Too often, her smell drives away her husband, family and friends.

Severe perineal tears: A growing need in the field

Severe perineal tears are another debilitating injury that can occur when a woman in labor does not have access to adequate care. The effects of this injury—a tearing to the anal sphincter muscle—leaves a woman incontinent of feces. In recent years, as our partners’ outreach workers have found women with fistula, they’ve increasingly encountered women with this similarly debilitating childbirth injury. Perineal tears now account for approximately 20% of the women we treat.

Fistula Foundation was honored as a 2024 Kristof Holiday Impact Prize winner by Nicholas Kristof, a two-time Pulitzer Prize winning journalist for The New York Times. Out of 1.8 million nonprofits in the U.S., the Foundation was chosen as one of three winners.

I can vouch for the charity as I was introduced to it long ago by my longtime friend Whitney Tilson, who served on the Board of the Foundation for a decade. Whitney grew up partly in Tanzania and has always been one of the most charitable people I have met.

The Foundation happens to be based out of San Jose, California, which is my hometown.

As is now custom, 5% of revenue earned by Cassandra Unchained during the month of February 2026 will go to Fistula Foundation.

The charity has also won many accolades throughout its existence for transparency and the impact of funds raised. Charity Navigator gives the Foundation a score of 100%, and Charity Watch gives the Foundation an A grade.

Fistula Foundation is active in 36 countries.