Obstetric Fistula: Africa’s silent epidemic

While all women of reproductive age are vulnerable to suffer fistula, the underage girls who are victims of child marriages, female genital mutilation and teenage pregnancies are at highest risk.

Obstetric Fistula is a silent epidemic in Africa. It’s a hole in the birth canal caused by prolonged, obstructed labour due to lack of timely and adequate medical care. As a result of this, in most cases, the baby is stillborn or dies within the first week of life, and the woman suffers a devastating injury, which leaves her incontinent. While all women of reproductive age are vulnerable to suffer fistula, the underage girls who are victims of child marriages, female genital mutilation and teenage pregnancies are at highest risk.

It’s a deeply unpleasant condition, resulting in constant leakage of urine and feaces through the vagina. Naana Otoo-Oyortey from the diaspora charity FORWARD tells me: “It’s a health issue that’s exacerbated by social factors. Many of these girls will be excluded from community life and abandoned by their husbands and families, isolating them socially and economically.”.

Another diaspora charity, MIFUMI, sent me a number of case studies. Justus Osuku, a peasant from Gweri in Soroti district, married his wife when they were both 14, during the infamous Teso insurgency in the 1990s. They were living in the Internally Displaced Peoples Camps in Soroti when his wife developed the problem. He resisted the social pressure to send her away: “I loved her. I married her when she was normal. I did not see the reason to send her away at a time when she needed me most.”

He is unusual: the overwhelming majority of husbands send their wives away, citing reasons ranging from the unbearable smell to community stigma. FORWARD is conducting research in Sierra Leone to explore the impact on the lives of women and girls who are blighted by it. The research involves 45 women affected by fistula and their recommendations will inform policy and decision makers in Sierra Leone and beyond.

One of those women, Jamma, was 18 when she got pregnant. When the labour started, she went to the local health centre but the nurse was away so she had to wait for three days. She finally gave to a stillborn baby and developed fistula. She suffered from it for two years until her friend told her about the treatment in the town. Her friend paid for her transport but the journey was very difficult. Nobody wanted to sit with her because of the smell. She was abandoned, first by her husband and then her grandmother.

On 23 May this year the UN celebrated the first International Day to End Obstetric Fistula. There is a lack of evidence as to how many women worldwide are living with the condition, but they live mainly in Sub Saharan Africa and Asia, and number in the hundreds of thousands. In Uganda there are at least 200,000 such women and 1,900 new cases are reported annually, according the National Obstetric Fistula Strategy.

“It’s a poor person’s illness,” Evelyn Schiller of MIFUMI tells me. “The issue of transport in rural Africa makes it difficult - there are very few cars in these areas. Surgeries can be lacking basic equipment like surgical gloves, clamps and oxygen. It usually takes three or four surgeries to correct it because it’s a complex repair process. We need to improve health education and antenatal care, train doctors to repair them, and above all raise awareness.” 

Mother and son walk together near the Ethiopia-Somalia border. Photograph: Getty Images

Alan White's work has appeared in the Observer, Times, Private Eye, The National and the TLS. As John Heale, he is the author of One Blood: Inside Britain's Gang Culture.

Photo: Getty Images
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What can you do about Europe's refugee crisis?

The death of a three-year-old boy on a beach in Europe has stirred Britain's conscience. What can you do to help stop the deaths?

The ongoing refugee crisis in the Mediterranean dominates this morning’s front pages. Photographs of the body of a small boy, Aylan Kurdi, who washed up on a beach, have stunned many into calling for action to help those fleeing persecution and conflict, both through offering shelter and in tackling the problem at root. 

The deaths are the result of ongoing turmoil in Syria and its surrounding countries, forcing people to cross the Med in makeshift boats – for the most part, those boats are anything from DIY rafts to glorified lilos.

What can you do about it?
Firstly, don’t despair. Don’t let the near-silence of David Cameron – usually, if nothing else, a depressingly good barometer of public sentiment – fool you into thinking that the British people is uniformly against taking more refugees. (I say “more” although “some” would be a better word – Britain has resettled just 216 Syrian refugees since the war there began.)

A survey by the political scientist Rob Ford in March found a clear majority – 47 per cent to 24 per cent – in favour of taking more refugees. Along with Maria Sobolewska, Ford has set up a Facebook group coordinating the various humanitarian efforts and campaigns to do more for Britain’s refugees, which you can join here.

Save the Children – whose campaign director, Kirsty McNeill, has written for the Staggers before on the causes of the crisis – have a petition that you can sign here, and the charity will be contacting signatories to do more over the coming days. Or take part in Refugee Action's 2,000 Flowers campaign: all you need is a camera-phone.

You can also give - to the UN's refugee agency here, and to MOAS (Migrant Offshore Aid Station), or to the Red Cross.

And a government petition, which you can sign here, could get the death toll debated in Parliament. 

 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog.