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.

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France’s burkini ban could not come at a worse time

Yet more legislation against veiled women can only further divide an already divided nation.

Since mayor of Cannes David Lisnard banned the full-body burkini from his town’s beaches, as many as 15 French resorts have followed suit. Arguments defending the bans fall into three main categories. First, it is about defending the French state’s secularism (laïcité). Second, that the costume represents a misogynistic doctrine that sees female bodies as shameful. And finally, that the burkini is cited as a threat to public order.

None of these arguments satisfactorily refute the claims of civil rights activists that the bans are fundamentally Islamophobic.

The niceties of laïcité

The Cannes decree explicitly invokes secular values. It prohibits anyone “not dressed in a fashion respectful of laïcité” from accessing public beaches. However, the French state has only banned “ostentatious” religious symbols in schools and for government employees as part of laïcité (the strict separation between the state and religious society). And in public spaces, laïcité claims to respect religious plurality. Indeed, the Laïcité Commission has tweeted that the ban, therefore, “cannot be based upon the principle of laïcité”.

While veils covering the entire face such as the burqa or niqab are illegal, this is not to protect laïcité; it is a security matter. The legal justification is that these clothes make it impossible to identify the person underneath – which is not the case for the burkini.

 

By falling back on laïcité to police Muslim women in this way, the Cannes authorities are fuelling the argument that “fundamentalist secularism” has become a means of excluding Muslims from French society.

Colonial attitudes

Others, such as Laurence Rossignol, the minister for women’s rights, hold that the burkini represents a “profoundly archaic view of a woman’s place in society”, disregarding Muslim women who claim to wear their burkini voluntarily.

This typifies an enduring colonial attitude among many non-Muslim French politicians, who feel entitled to dictate to Muslim women what is in their best interests. Rossignol has in the past compared women who wear headscarves through choice to American “negroes” who supported slavery.

Far from supporting women’s rights, banning the burkini will only leave the women who wear it feeling persecuted. Even those with no choice in the matter are not helped by the ban. This legal measure does nothing to challenge patriarchal authority over female bodies in the home. Instead, it further restricts the lives of veiled women by replacing it with state authority in public.

Open Islamophobia

Supporters of the ban have also claimed that, with racial tensions high after recent terrorist attacks, it is provocative to wear this form of Muslim clothing. Such an argument was made by Pierre-Ange Vivoni, mayor of Sisco in Corsica, when he banned the burkini in his commune. Early reports suggested a violent clash between local residents and non-locals of Moroccan origin was triggered when strangers photographed a burkini-wearing woman in the latter group, which angered her male companions. Vivoni claimed that banning the costume protected the security of local people, including those of North African descent.

Those reports have transpired to be false: none of the women in question were even wearing a burkini at the time of the incident. Nonetheless, the ban has stood in Sisco and elsewhere.

To be “provoked” by the burkini is to be provoked by the visibility of Muslims. Banning it on this basis punishes Muslim women for other people’s prejudice. It also disregards the burkini’s potential to promote social cohesion by giving veiled women access to the same spaces as their non-Muslim compatriots.

Appeals to public order have, occasionally, been openly Islamophobic. Thierry Migoule, head of municipal services in Cannes, claimed that the burkini “refers to an allegiance to terrorist movements”, conveniently ignoring the Muslim victims of recent attacks. Barely a month after Muslims paying their respects to friends and family killed in Nice were racially abused, such comments are both distasteful and irresponsible.

Increased divisions

Feiza Ben Mohammed, spokesperson for the Federation of Southern Muslims, fears that stigmatising Muslims in this way will play into the hands of IS recruiters. That fear seems well-founded: researchers cite a sense of exclusion as a factor behind the radicalisation of a minority of French Muslims. Measures like this can only exacerbate that problem. Indeed, provoking repressive measures against European Muslims to cultivate such a sentiment is part of the IS strategy.

Meanwhile, the day after the incident in Sisco, riot police were needed in nearby Bastia to prevent a 200-strong crowd chanting “this is our home” from entering a neighbourhood with many residents of North African descent. Given the recent warning from France’s head of internal security of the risk of a confrontation between “the extreme right and the Muslim world”, such scenes are equally concerning.

Now more than ever, France needs unity. Yet more legislation against veiled women can only further divide an already divided nation.

The Conversation

Fraser McQueen, PhD Candidate, University of Stirling

This article was originally published on The Conversation. Read the original article.