My anthropologically grounded research examines two seemingly disparate topics about familial decisions and female reproductive health in developing countries: (i) whether to circumcise girl children, and (ii) whether and how to help a woman get a surgical repair of an obstetric fistula. Family decision-making about these two dilemmas shares common threads of influence that are deeply enmeshed in social and economic transactions within families’ broader communities. Commonalities among these transactions permit insight into why female circumcision remains meaningful for practicing communities, and why some women who suffer an obstetric fistula get a repair relatively easily and others remain in a reproductive health liminal state. My ultimate goal is to develop a new model of familial decision making about female reproductive health. The circumcision research was conducted in Africa (Kenya, Uganda, and Ethiopia). The fistula research included Ghana and Bangladesh.