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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David Cameron: "Taking more and more refugees" is not the answer to the migration crisis

As the migrant crisis worsens, the Prime Minister refuses to allow desperate people into Britain, citing "peace" in the Middle East as his priority.

David Cameron says "taking more and more refugees" is not the answer to the global migration crisis.

Amid calls for the UK to allow more people in, to help ease the record numbers of migrants entering Europe and to provide asylum for desperate people attempting to cross the border, the Prime Minister insists upon keeping the UK's doors closed.

Preferring to focus on the situation in the Middle East, Cameron commented:

We are taking action across the board... the most important thing is to try to bring peace and stability to that part of the world . . . I don't think there is an answer that can be achieved simply by taking more and more refugees.

His words come on the day that harrowing photos of a young Syrian boy, washed up dead on a beach near the Turkish resort of Bodrum, have been published. The child was from a group of 12 Syrian refugees who drowned attempting to reach Greece.

The Labour leadership candidates are taking a different stance. In a much-praised speech this week, Yvette Cooper urged the UK to take in 10,000 more refugees, warning that a failure to do so would be, “cowardly, immoral and not the British way”.

Andy Burnham too has called for Britain to take more people in (or, in his words, "share the burden"): "This is a humanitarian crisis, not just a tedious inconvenience for British holidaymakers, as our government might have us believe."

Now read this week's leader on the migration crisis, "The wretched of the earth", calling for the UK to accept more asylum seekers

Anoosh Chakelian is deputy web editor at the New Statesman.