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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On the "one-state" solution to Israel and Palestine, what did Donald Trump mean?

The US President seemed to dismantle two decades of foreign policy in his press conference with Benjamin Netanyahu. 

If the 45th President of the United States wasn’t causing enough chaos at home, he has waded into the world’s most intricate conflict – Israel/Palestine. 

Speaking alongside Israeli Prime Minister Benjamin Netanyahu, Trump made an apparently off-the-cuff comment that has reverberated around the world. 

Asked what he thought about the future of the troubled region, he said: “I’m looking at two-state and one-state and I like the one that both parties like.”

To the uninformed observer, this comment might seem fairly tame by Trump standards. But it has the potential to dismantle the entire US policy on the Israeli-Palestinian peace process. Trump said he could "live with" either a two-state or one-state solution. 

The "two-state solution" has become the foundation of the Israel-Palestine peace process, and is a concept that has existed for decades. At its simplest, it's the idea that an independent state of Palestine can co-exist next to an independent Israel. The goal is supported by the United Nations, by the European Union, by the Arab League, and by, until now, the United States. 

Although the two-state solution is controversial in Israel, many feel the alternative is worse. The idea of a single state would fuel the imagination of those on the religious right, who wish to expand into Palestinian territory, while presenting liberal Zionists with a tricky demographic maths problem - Arabs are already set to outnumber Jews in Israel and the occupied territories by 2020. Palestinians are divided on the benefits of a two-state solution. 

I asked Yossi Mekelberg, Professor of International Relations at Regent's University and an associate fellow at Chatham House, to explain exactly what went down at the Trump-Netanyahu press conference:

Did Donald Trump actually mean to say what he said?

“Generally with President Trump we are into an era where you are not so sure whether it is something that happens off the hoof, that sounds reasonable to him while he’s speaking, or whether maybe he’s cleverer than all of us put together and he's just pretending to be flippant. It is so dramatically opposite from the very professorial Barack Obama, where the words were weighted and the language was rich, and he would always use the right word.” 

So has Trump just ditched a two-state solution?

“All of a sudden the American policy towards the Israel-Palestine conflict, a two-state solution, isn’t the only game in town.”

Netanyahu famously didn’t get on with Obama. Is Trump good news for him?

“He was quite smug during the press conference. But while Netanyahu wanted a Republican President, he didn’t want this Republican. Trump isn’t instinctively an Israel supporter – he does what is good for Trump. And he’s volatile. Netanyahu has enough volatility in his own cabinet.”

What about Trump’s request that Netanyahu “pull back on settlements a little bit”?

“Netanyahu doesn’t mind. He’s got mounting pressure in his government to keep building. He will welcome this because it shows even Trump won’t give them a blank cheque to build.”

Back to the one-state solution. Who’s celebrating?

“Interestingly, there was a survey just published, the Palestinian-Israel Pulse, which found a majority of Israelis and a large minority of Palestinians support a two-state solution. By contrast, if you look at a one-state solution, only 36 per cent of Palestinians and 19 per cent of Israel Jews support it.”

 

 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.