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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No, identity politics is not to blame for the failures of the left

This is no time to back away from our commitment to women’s rights, racial justice and sexual equality.

In these troubled times, it's good to know that moderate conservatives, anxious liberals and even your neighbourhood Trotskyist uncle can come together against the common enemy: students. Prissy, stuck-up students, with their trigger warnings and political correctness and highfalutin ideas about racial justice. It must be their fault. Forget the gurning neo-fascists goose-stepping into power across the globe, it's the students who are the real enemy. If they hadn't been so hung-up on identity politics, we wouldn't be staring into this abyss. You know I'm right.

That was me being sarcastic. The reason I need to point that out is that on or around 9 November 2016, the age of irony gave way to a new one of deadpan sincerity. It happened at some point between the election of an orange billionaire tycoon to the White House and authorities condemning Native American protesters at Standing Rock under the outgoing administration. So, unfortunately, I must be clear: no, I don't think that “identity politics” is the greatest threat to western civilisation. Some people, however, really do, and are at pains to point out that this geopolitical disaster could have been avoided if we had all been less precious about gay rights and women's rights and black lives and concentrated on the issues that matter to real people. Real people meaning, of course, people who aren't female, or queer, or brown, or from another country. You know, the people who really matter.

In the wake of successive victories for the venal far-right, commentators from all sides of the self-satisfied, chin-stroking debate school are blaming “identity politics” for the disaster on our doorsteps. What they seem to mean by this is “politics that matter to people who aren't white men in rural towns”. I have always thought of that simply as politics, but according to Mark Lilla, writing in the New York Times, I was mistaken. Diversity, Lilla writes, is:

“A splendid principle of moral pedagogy  but disastrous as a foundation for democratic politics in our ideological age. In recent years American liberalism has slipped into a kind of moral panic about racial, gender and sexual identity that has distorted liberalism’s message and prevented it from becoming a unifying force capable of governing.”

This is an idea that has remarkable staying power across a fractious and divided left: the idea that issues of race, gender and sexuality are at best a distraction from class politics, and at worst a bourgeois tendency that will be destroyed after the revolution. The logic is that by focusing on issues of social justice, the political class has abandoned “real” working people to economic hardship.

This notion is horribly wrong, and the worst thing is that it's wrong in the right direction, a train of thought that stays safely on track right until it slams into the hoardings next to the station. The political class has indeed rolled over and let kamikaze capitalism wreck the lives of working people around the world. Identity politics, however, has little to do with that cowardice. That the two are now yoked together in the popular imagination is something the left must answer for.

All politics are identity politics, but some identities are more politicised than others. The notion that the politics of identity and belonging have been allowed to overwhelm seemingly intractable issues of class, power and poverty is, in fact, entirely correct  but this is not a problem for the traditional left. It is a problem for the traditional right, which has pursued a divide-and-conquer strategy for centuries, pitting white workers against black and brown workers, men against women, native-born citizens against foreigners in a hierarchy of victimhood that diverts energy and anger away from the vested interests bankrolling the entire scheme.

As journalist Michelle Garcia noted, responding to Lilla in the New York Times:

 “The attack on political correctness fits within the brand of identity politics Donald Trump exploited during his campaign. Mr Trump's victory relied on fusing a culture of racism and sexism with economic anxieties and the backlash against neoliberalism.”

It's a shell-game. A con. It did not start with Donald Trump, but the real-estate mogul and social media tantrum-artist has taken it to its logical conclusion. The president-elect and his fellow travellers and sugar daddies have committed political fraud against the entire western world. They have compounded it – as all good fraudsters do – by making us believe that it was our fault for being so naive in the first place.

It is, to some extent, reassuring to believe that it’s all our fault. If it’s all our fault for being too politically-correct, too committed to “diversity”  if it were liberals and leftists who messed up by listening to these whining hippies with their patchouli-scented ideals of fairness and tolerance and police not shooting young black men dead for no reason  we might have to face the much scarier notion that what’s happening is, in fact, beyond our control. Instead, those who should know better are encouraging the most vulnerable to throw themselves under the bus for the greater good. This is not just offensive. It is also stupid.

The truth is that social justice and economic justice are not mutually exclusive. Those who would sacrifice one for the other will end up with neither, which is of course what the unscrupulous narcissists manspreading at the gates of power are counting on. The mainstream political left has, for generations, been unable to answer the core economic issues that  shocking, I know, but hear me out  affect the lives of all human beings, of every race, gender and background. For generations, in the face of late capitalist hegemony, all it could realistically achieve was to tweak the system incrementally, making things a little fairer for individual groups, without challenging the structural inequalities that created the injustice in the first place. This must change, and soon. Not just because of “fine moral principles”. Trying to fix economic policy without tackling structural inequality is not just morally misguided  it is intellectually bankrupt.

Race, gender and identity are not side issues in the current crisis. On the contrary. Capitalism has always divided its labour supply along lines of race and gender, ensuring that in times of unrest, we don't start burning our looms  far safer for us to set fire to one other. All politics are identity politics, and this is no time to back away from our commitment to women’s rights, racial justice and sexual equality. This is when we double down. The fight against the corporate neo-fascism funnelling out of every television set is not a fight that can be won if liberals, leftists and social justice campaigners turn on one another. It is a fight that we will win together, or not at all.

Laurie Penny is a contributing editor to the New Statesman. She is the author of five books, most recently Unspeakable Things.