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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French presidential election: Macron and Le Pen projected to reach run-off

The centrist former economy minister and the far-right leader are set to contest the run-off on 7 May.

Emmanuel Macron and Marine Le Pen will contest the run-off of the French presidential election, according to the first official projection of the first-round result.

Macron, the maverick former economy minister, running under the banner of his centrist En Marche! movement, is projected to finish first with an estimated 23.7 per cent of the vote, putting him marginally ahead of Le Pen. The leader of the far-right Front National is estimated to have won 21.7 per cent, with the scandal-hit Républicain François Fillon and the left-winger Jean-Luc Mélenchon tied for third on an estimated 19.5 per cent each. Benoît Hamon, of the governing Socialist Party, is set to finish a distant fourth on just 6.2 per cent. Pollsters Ifop project a turnout of around 81 per cent, slightly up on 2012.

Macron and Le Pen will now likely advance to the run-off on 7 May. Recent polling has consistently indicated that Macron, who at 39 would be the youngest candidate ever to win the French presidency, would probably beat Le Pen with roughly 60 per cent of the vote to her 40. In the immediate aftermath of the announcement, he told Agence France Presse that his En Marche! was "turning a page in French political history", and went on to say his candidacy has fundamentally realigned French politics. "To all those who have accompanied me since April 2016, in founding and bringing En Marche! to life, I would like to say this," he told supporters. " 'In the space of a year, we have changed the face of French political life.' "

Le Pen similarly hailed a "historic" result. In a speech peppered with anti-establishment rhetoric, she said: "The first step that should lead the French people to the Élysée has been taken. This is a historic result.

"It is also an act of French pride, the act of a people lifting their heads. It will have escaped no one that the system tried by every means possible to stifle the great political debate that must now take place. The French people now have a very simple choice: either we continue on the path to complete deregulation, or you choose France.

"You now have the chance to choose real change. This is what I propose: real change. It is time to liberate the French nation from arrogant elites who want to dictate how it must behave. Because yes, I am the candidate of the people."

The projected result means the run-off will be contested by two candidates from outside France's establishment left and right parties for the first time in French political history. Should Le Pen advance to the second round as projected, it will mark only the second time a candidate from her party has reached the run-off. Her father, Jean-Marie Le Pen, reached the second round in 2002, but was decisively beaten by Jacques Chirac after left-wingers and other mainstream voters coalesced in a so-called front républicain to defeat the far right.

Fillon has conceded defeat and backed Macron, as have Hamon and the French prime minister, Bernard Cazeneuve. "We have to choose what is best for our country," Fillon said. "Abstention is not in my genes, above all when an extremist party is close to power. The Front National is well known for its violence and its intolerance, and its programme would lead our country to bankruptcy and Europe into chaos.

"Extremism can can only bring unhappiness and division to France. There is no other choice than to vote against the far right. I will vote for Emmanuel Macron. I consider it my duty to tell you this frankly. It is up to you to reflect on what is best for your country, and for your children."

Though Hamon acknowledged that the favourite a former investment banker – was no left-winger, he said: "I make a distinction between a political adversary and an enemy of the Republic."

Mélenchon, however, has refused to endorse Macron, and urged voters to consult their own consciences ahead of next month's run-off.

The announcement sparked ugly scenes in Paris in the Place de la Bastille, where riot police have deployed tear gas on crowds gathered to protest Le Pen's second-place finish. Reaction from the markets was decidedly warmer: the euro hit a five-month high after the projection was announced.

Now read Pauline Bock on the candidate most likely to win, and the NS'profiles of Macron and Le Pen.

 

Patrick Maguire writes about politics and is the 2016 winner of the Anthony Howard Award.

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