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.

The Alternative
Show Hide image

"I won't do this forever": meet Alternative leader, Uffe Elbæk – Denmark's Jeremy Corbyn

The Alternative party leader speaks frankly about his party's journey from being seen as a comedy sideshow to taking nine seats in the Danish elections.

In Britain, popular anti-politics sentiment has engulfed the Labour party, through Jeremy Corbyn. In Denmark's splintered, assorted political landscape, it has created a party called the Alternative. The barely two-year-old party was depicted as a comedic sideshow before June's elections. But with nine of 179 seats, they embarrassed all electoral predictions, including their own. Their rise owes to a growing European gripe with politics as usual, as well as to growing chasms within Danish politics.

"I don't want to do this forever. I want to be a pensioner, lay on a beach somewhere, write books and make money from speeches." Embracing his maverick figure, the 61-year-old witty, self-deprecating leader, Uffe Elbæk, has become one of the most resonant voices in Danish politics. As an ex-culture minister he was tarred by conflict of interest accusations leading to him to voluntarily step down as minister in 2012. He was later cleared of wrongdoing but the ridicule in the media stuck. His re-emergence in Danish politics is no longer trivial. His party has struck a match on a sentiment he claims is not European but international.

"What we see across Europe is a growing divide between politicians and their electorate. We are trying to bridge that divide and move from a representative democracy to a far more involving democracy. You see the same in the Scottish Referendum, in Syriza, in Podemos, in a way in Bernie Sanders and, of course, in Jeremy Corbyn".

In tandem with the rise of populist parties in Europe, they've capitalised on a discontent with mainstream politics, perceived spin and sound bite. In the last elections, the Alternative refused to directly persuade the electorate to vote for them, instead encouraging them to vote on their convictions.

“We are critical of the neoliberal doctrine from Thatcher and Reagan and growing inequality," explains Elbæk. "But I believe deeply in human potential and creating a more entrepreneurial, creative society based on progressive values".

The party decides its policies in what they call "political laboratories" where members and non-members are invited to share, hone, and develop policy ideas. The party is in many respects what it says on the tin. Despite flinching away from left and right political categories, they are staunchly pro-environment and pro-immigration.

"A lot of progressives do a lot of good things in the grassroots, but the reality is that few want to go into the big party machines." The Alternative has been a huge grassroots built campaign, attracting exactly those types of voters. It has gained over 6,000 members in its first two years, a remarkable feat as membership across Danish political parties steadily declines.

The party appeals to a desire, more prominent on the left of the Danish electorate, for a straight-talking, green party not overtly party political but reminiscent of conventionally Scandinavian values of tolerance and consensus. It is hawkish about whether socialist-inspired thinking is condusive to modern challenges, but similarly it believes in harnessing public support directly. They are a growing albeit slightly hippy and unconventional vehicle for political expression.

The migrant crisis has exposed chasms in Danish politics. Controversial proposals to advertise anti-refugee adverts, by integration minister Inger Støjberg, have sparked widespread concern. From across politics and from business, there has been a steady reel of expressed concern that Denmark risks creating a perception of intolerance to foreigners.

A private Danish group called People Reaching Out, published adverts in the same four Lebanese newspapers that ran the anti-refugee ads. Crowdfunding over £16,000, they replicated the original ads writing, "sorry for the hostility towards refugees expressed here. From people's to people's we wish to express our compassion and sympathy to anyone fleeing war and despair".

Michala Bendixen, who heads the campaign group, Refugee's Welcome, wrote an op-ed in The Daily Star, one of the Lebanese papers which carried the ad. She stated that, "the adverts give a completely distorted picture of the situation", clarifying that the Danish asylum process was amongst the fastest in Europe.

Støjberg's reforms to immigration and almost 50 per cent cuts to refugee benefits have made her a controversial figure but despite much criticism, topped a recent poll of ministers in the current government that voters felt were doing well. Largely on the back of a hardline position on immigration, the Danish People's Party won 21 per cent of the popular vote in this year's elections. Similarly to many countries across Europe, the migrant crisis has been emotive and polarising. On that divide, the Alternative has been categorical.

"In Denmark there is one thing happening in politics and another in the streets," says Elbæk. "There is a disgraceful lack of empathy from politicians but the reaction from the Danish people has been really touching. Suddenly we were seeing hundreds of refugees on our motorways, and it came as a reality shock to the Danish people. But they responded to it by offering shelter, food, water, and blankets."

Denmark's new government is hardening its position on immigrants and refugees. The split reaction reflects a more polarised terrain. There is a debate about what Denmark's values really are, and whether the migrant crisis betrays or protects them. Within it, the Alternative, partly motley, but with a non-trivial and rising electoral appeal, are an increasingly influential voice.