The closest I come to wanting a baby right now is watching Blair on “Gossip Girl” and adding to my potential baby name list (which is only a mental list, don’t worry). But I know that someday I want to be a mother. And when I make that decision I am confident I will have a safe and healthy pregnancy and delivery. Unfortunately, many women do not have this luxury. There are currently more than 2 million women suffering from untreated obstetric fistulas. That is a huge number and yet, if you ask around, you will find that many people do not know what an obstetric fistula is.
What is an obstetric fistula?
An obstetric fistula is a hole in the birth canal that is caused by obstructed labor. When labor ceases to progress, a baby’s head can become stuck in the pelvis; women who experience obstructed labor can suffer for days in labor. Many die from a ruptured uterus or pure exhaustion. Those that survive to give birth to a stillborn child are not relieved of their pain. The prolonged pressure of the baby’s head on the pubic bone creates a decrease in the blood supply to the tissues there and rots them away. This creates a hole between the genital tract and the bladder or the rectum, sometimes both.
What does this hole mean?
Women who develop obstetric fistulas suffer physical and emotional trauma. They experience constant incontinence, the inability to control ones bowels. These women must walk around continuously dripping urine and feces. As a result they are frequently divorced by their husbands and ostracized from their communities. They are ashamed and alone. Many women drink very little water to try and stem the flow of urine. This only concentrates the urine, which causes painful sores on the legs of the fistula patient. Additionally, the pressure of the baby’s head on the lumbar vertebrae often causes nerve damage. Although this damage is eventually reversible, many women are initially somewhat paralyzed after the formation of a fistula. Imagine loosing a child and then having to deal with the social and physical consequences of a fistula. Not surprisingly, women with fistulas are depressed and many seriously consider suicide. While researching this topic I read about one young woman who developed a fistula at the age of fourteen while giving birth to her first child. She was divorced by her husband and returned home to live with her mother. For six years she lived curled into the fetal position in a small hut. As a result she developed contractures, which 2 percent of fistula patients experience, and is now unable to straighten her legs. I realized that this woman is now 20 years old, the same age as I am.
Can these women heal?
95 percent of fistulas can be closed with a surgical procedure that costs $300. Even contractures can be alleviated with time and physical therapy. But most women who experience fistulas do not receive surgery or medical help. They are poor and rural and, most importantly, they are not a priority. There is a strong correlation between countries where women are marginalized and countries with high rates of obstetric fistulas. The majority of women who suffer from obstetric fistulas are in Sub-Saharan Africa and Asia. Believe it or not, obstetric fistulas were once a significant problem in the United Sates. There was even an obstetric fistula hospital where the Waldorf Astoria hotel is today in New York City. Why are they no longer a problem in the U.S.? Clearly we have the medical systems and resources to prevent obstetric fistulas. A woman in the U.S. receives a cesarean section before she is even at risk for an obstetric fistula. But are we secure only because we are wealthier than the countries where women are still at risk? To some extent yes, but poverty is not the only culprit. Maternal mortality in the U.S. did not significantly decrease until the 1920’s. Incomes and access to doctors had increased long before that time. It was not until women gained the right to vote and became influential citizens that the issues of maternal injury and mortality were addressed. Even in poverty stricken countries, maternal mortality and fistula rates can be significantly decreased if they are considered important. India has a greater GNP than Sri Lanka but a woman is 8 times more likely to die in childbirth in India than in Sri Lanka. This is because Sri Lanka has given safe pregnancy and childbirth precedence and has allocated its funds to health structures developed to ensure the safety of expectant mothers. Women are not suffering and dying because obstetric fistulas are unpreventable or untreatable but because the society they live in does not deem them worth saving.
What needs to be done?
Obstetric fistulas are devastating but preventable conditions that need to be addressed and deserve far more attention. This is purely a human rights issue; these women deserve to have safe deliveries for no reason other than they are human beings. We, as a world community, can and must do something about maternal injuries and death. If we can spend $40 billion a year on pet food then we can set money aside to prevent and treat obstetric fistulas.
Mant of us will become mothers some day and we all feel a connection and responsibility to our fellow women. As such, I implore you to do something: research, donate, or volunteer.
Sources:
http://www.hamlinfistula.org.au/obstetricfistula/patientstories.html
http://www.who.int/features/factfiles/obstetric_fistula/en/
http://www.glowm.com/resources/glowm/pdf/POFS/POFS_full.pdf
Kristof, Nicholas D., and Sheryl WuDunn. Half the Sky. New York: Vintage, 2010. Print.