The horror of obstetric fistulas is finally getting some attention — hopefully this will result in increased aid to reproductive health for women in developing nations.
What brings the girls to Dr. Waaldijk – and him to Nigeria – is the obstetric nightmare of fistulas, unknown in the West for nearly a century. Mostly teenagers who tried to deliver their first child at home, the girls failed at labor. Their babies were lodged in their narrow birth canals, and the resulting pressure cut off blood to vital tissues and ripped holes in their bowels or urethras, or both.
Now their babies were dead. And the would-be mothers, their insides wrecked, were utterly incontinent. Many had become outcasts in their own communities – rejected by their husbands, shunned by neighbors, too ashamed even to step out of their huts.
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Dr. Waaldijk remembers one patient well. She managed to push out only her baby’s head before collapsing from exhaustion in her hut, he said. Her brother carried her, balanced on a donkey, to a road, where a bus driver demanded 10 times the usual fare to take her to a hospital. She half-stood, half-sat for the trip, her dead baby’s head between her legs, her urethra ripped open.
“This is what is happening,” the doctor said. “Nobody will believe it.” The fistulas point to the broader plight of millions of African women: poverty; early marriage; maternal deaths; a lack of rights, independence and education; a generally low standing. One in 18 Nigerian women dies during childbirth, compared with one in 2,400 in Europe, the Population Fund says. A larger share of African women die in childbirth than anywhere else in the world.
And the problem, as the Times shows, affects women young and old:
Nearly 600 women showed up, some arriving in busloads, when international and Nigerian officials staged a 14-day treatment campaign at Babbar Ruga and three other hospitals in February. Three hospitals ran out of beds. The youngest patient was 12.
The oldest, more than 70, had been incontinent for a half-century.
Part of the problem is that these girls are being married off as children, and having children at a very young age — according to the doctor, about a third of his patients are under the age of 15. They don’t have the right to refuse sex, to refuse early marriage, to divorce, and in some countries to own their own land. They don’t have access to birth control or sexual health information. They certainly don’t have access to the basic medical care that would prevent most of these injuries. And U.S. international aid packages require that we just tell African women, “Be abstinent until marriage.”
The UNFPA has a comprehensive campaign to end fistula in Africa (as a sidenote, the Bush administration has again cut funding to the UNFPA this year). Contribute if you can.