Book Review: No Woman Left Behind

Reviewed by Andrea Marks-Joseph

Part career memoir, part nonprofit guidebook—entirely inspiring

No Woman Left Behind follows Kate Grant in her journey from working in the advertising industry—having checked all the career boxes she aimed for—and wondering if she could make a more powerful impact on society.

This tremendous, unpredictable, unparalleled journey leads Grant to find (then lose, then reconnect with, then lose again, only to succeed far beyond expectations) her calling at the Fistula Foundation. 

The Fistula Foundation has done groundbreaking, lifesaving work in raising awareness about the needless traumatic childbirth injury (caused by inaccessible medical services and various gender inequality issues) that results in the development of a fistula (a hole, often between the vagina, bladder or rectum), which leaves women continuously leaking urine, feces, or both and consequently rejected by their husbands and communities. 

The Foundation also raises funding for hospitals throughout the world (this avoidable childbirth injury is most prevalent in Africa and Asia’s most rural, poorest regions) which provide the relatively simple surgical repair of fistulas, offering these women a new beginning to their lives, often after years of isolation due to shame and misinformation about their incontinence.

No Woman Left Behind is an immensely valuable guidebook for women working (or aspiring to work) in nonprofits, a wake-up-call to anyone feeling unfulfilled working in policy and government-funded services. It’s a book about how it’s not too late to change careers and make meaningful change that feels personal and important.

If you’re looking for an empowering read that will enlighten you to a societal issue and its daring (yet deceptively simple) solution, and bring you along the winding road toward each step of its success, you’ll get what you’re looking for and feel inspired from this book. 

My heart broke reading about the young Ethiopian woman whose “family all contributed money for the bus fare” into the city when her neighbor learned that fistula treatment was possible, only for her to get “kicked off the bus because she was leaking. So she walked the last five kilometers” to the hospital. 

And my heart soared each time the small group of go-getters at the Fistula Foundation office rallied their way into winning landscape-shifting publicity or funding that could bring even a handful more women the healing that this brave Ethiopian woman, and millions of other woman globally, prayed for. The No Woman Left Behind narrative is powerful and provides a fascinating perspective of feminism that feels modern and fresh in the canon of women’s history.

The quotes at the start of each chapter can feel disjointed from the contents of some chapters. They set up expectations of the forthcoming story but will occasionally do it inaccurately and seemingly out of context. Some quotes, of course, fit well, like an African proverb as a suggested business practice or a college advisor quoting Kurt Vonnegut at an important juncture of her life: “A step backward, after making a wrong turn,” truly is “a step in the right direction.”

Though she worked behind the scenes in major movements in advertising and government, author Kate Grant doesn’t always see that what she’s seeing is strategic storytelling and not exactly truth. Some of her opinions feel predictable and untrue to the broader truth. I was occasionally disappointed and perplexed by the lack of meaningful consideration of race. Grant also praises pharmaceutical company Johnson & Johnson, even if briefly, which seems an odd choice for a book related to people living on the African continent over the last decade. But her heart is in the right place. She is willing to admit her mistakes, and she has been able to shape her aims into a tremendous, global impact, so I can’t hold it against her. 

I was moved by Grant’s frequent openness to share her mistakes, her errors, her embarrassments, and admit in specific situations that she may not have responded with as much patience or consideration as she recalls in the way she relays past events to us. Countless women will learn vital lessons from this willingness to share her professional (and personal) failures so unselfishly and unselfconsciously, whether it be her romantic relationships or raising issues in her boardroom meetings. The author takes us as far back as her first advertising job and fledgling internships in the 80s, through the 2008 financial crisis and the development of the internet, to as recently as organizational decisions in the years following the COVID-19 lockdowns—and still she manages to surprise and impress us with valuable teachable moments.

Grant brings us along on her discovery of the natural ineffectiveness of US foreign aid policies and provides examples of how the UN and USAID fails the people it claims to serve on the ground. These are lessons many of us had to learn the hard, heartbreaking way—from the realities of security precautions in expat life, to concerns about transparency at the highest level of aid work, where she worked with names and faces you’ll recognize from news channels, C-SPAN, assigned college readings, and pop culture.

The conversations she shares, and even the specifics of professional dealings with organizations, donors, and remarkable women will ensure that No Woman Left Behind is an invaluable tool for anyone with genuine interest in what it’s like to work in the global nonprofit sector. Kate Grant explores the impact of media moments like an interview on the Oprah show or being featured by a prominent writer in his New York Times’ columns and how she was able to steer the foundation into a direction where it could become a major operation, which she described as the “Smile Train of Vaginas.” 

“The late Egyptian public health leader Professor Mahmoud Fathalla said it powerfully: “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to decide their lives are worth saving.” 

No Woman Left Behind and the Fistula Foundation must be praised for its direct intentions to address, publicize and mobilize to reduce and prevent thesystemic failures that allow for the fistulas to be created in the first place. The Foundation taking this forward-thinking and unwavering direction with imaginative, detailed planning is down to Kate Grant’s “imposter” status, and her heart truly being in helping the women, but also in her drive to execute her solution-driven plans to the fullest.

These were not talking points to Grant, and they are not simply stories that make good marketing copy. She’s in this business to eradicate a societal failure that has become a medical one, robbing women of their social lives and stealing the joy and wisdom these women would bring into their communities had they not been isolated from them due to their incontinence. Part of this remarkable outlook is the author’s understanding and commitment to ensuring that local doctors are empowered with the skills to serve their own people in-country. That is in itself rare and commendable.

It feels like a gift that the author brings us along on the ups and downs of her professional journey so openly: From the in-country hospital CEO replacement and consequent board failures that resulted in the devastating group-resignation of local doctors to the board meeting moment when “the hazy dream I’d had when I left Madison Avenue more than a decade earlier to try to make a small dent in global poverty had finally started to come into focus.”

No Woman Left Behind is a window into the stories of women who were almost immediately isolated and rejected by their husbands and communities after their traumatic childbirths, most of whom lived in the emotional darkness, loneliness, and medical neglect of the resulting fistula for years. 

This is also the story of the women—hospital volunteers, surgeons, doctors in training, translators, fundraisers, board members, donors, investors, office workers in nonprofit admin offices, and so many more—who have worked fiercely and terribly hard for the opportunity to provide a surgery that could repair the fistula and bring them confidently back into their social and academic lives.

Readers should be aware that throughout the book, the author recounts the harrowing stories of teenage girls who were raped and whose traumatic birthing experiences sometimes involving rape, others neglect, most of which resulted in stillbirths and the development of the fistula. These stories are painful every time, heartbreaking every time, no matter how concisely she tells them, no matter how many smiles are packed into either side of her visit to their hospital bed.

No Woman Left Behind would be a great choice for young adults with interest in this sector, whether to volunteer in the region or study with intentions to work in a field that will help alleviate the effects of global and gender inequality. It’s also a book for those working in the nonprofit sector, as the author’s hard-won lessons on clear dos and don’ts could save crucial on-the-ground relationships from being fractured and save them months of internal battles with colleagues.

It’s impossible not to be impressed and grateful for the lives saved and changed by the author’s fearless commitment to honoring all the women she works with and all the women she was able to help at the Fistula Foundation. Readers will feel inspired by her commitment and empowered by her fierce passion in her closely-held life’s mission. It’s never too late. After all, how could it be, if it’s a step in the right direction.

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