Obstetric fistulas

“Zegewhechu Kassa is just a typical sixteen girl in Ethiopia. She had the typical childhood, a typical family. When she was six years old, she was married to a man she did not know. Two months after her wedding, she was divorced. At age nine, she was married again and became pregnant when she was twelve. Her child died after three days of labor, but Zegewhechu miraculously survived with an obstretic fistula. Her second husband divorced her, her family left her in seclusion. Zegewhechu is not alone with her type of story—50% to 70% of girls under the age of eighteen in developing countries have similar stories to tell.”

The above is an introduction to an english paper I wrote about four or five years ago. The quarter before writing this, I had taken a women's studies course simply because it was a graduation requirement and it seemed easy, but it ended up being one of the most enlightening classes I had ever taken. I write this post hopefully to enlighten random readers, to increase awareness about something that I wish more people knew more about.

So to begin with, recall what you were doing at the age of five. You might've been playing dress-up, chasing girls if you were a boy, running away from boys if you were a girl, wearing light-up shoes with cartoon characters on them, eating chapstick, waking up early to watch Saturday morning cartoons (and maybe you still do), etc. Life was bliss and you had it made.

But of course, life isn't like this for all kids. Zegewhechu Kassa, mentioned in my intro, was already married. It's normal in some countries where families are just too poor to take care of their children. Daughters are married away to men twice their age without their permission--it's a way for parents to better their daughters' lives and their reputation. It's their parents way to show their love. They have no choice. But I'm not writing this post to argue for or against early marriage. I just want to talk about one of the effects of it.

Early marriage has severe consequences for a powerless female in impoverished countries: coerced sex, early pregnancy, and the main focus of this blog, obstetric fistulas. Young girls who are twelve (so still in middle school) simply do not have the developed bodies to undergo pregnancy. Their pelvic bones are underdeveloped, they're still small in body stature, and in impoverished countries, they're extremely malnourished. Some or all of these factors lead up to days and days of painful prolonged labor (and this is without the pain meds, which seem like an absolute necessity for women undergoing labor). When this happens, a cesarean section is the best bet to relieve the pressure, but most often, it's not even an option due to a lack of resources. Labor becomes prolonged, lasting up to THREE days for Zegewhechu. In the most severe cases, if you can even believe this, labor can last up to a week. The fetus doesn't even make it and just dies inside the body. But the girl's nightmare doesn't even end there.

Because I'm not the most well-versed on human anatomy, here's an explanation from the Campaign to End Fistula that explains how the fistula forms during prolonged labor:

"During the prolonged labour, the soft tissues of the pelvis are compressed between the descending baby's head and the mother's pelvic bone. The lack of blood flow causes tissue to die, creating a hole between the mother's vagina and bladder (known as a vesicovaginal fistula), or between the vagina and rectum (causing a rectovaginal fistula) or both."

How the hole forms isn't as important as what its effects are. This hole that forms results in the constant leaking of your urine and/or feces. Imagine this happening to yourself and not being able to hold in your own urine at the age of 16, an age when you should be learning to drive. How would you feel among your peers? How would they treat you? Zegewhechu’s second husband, like most husbands with a wife with an obstetric fistula, left her. She lived in seclusion with her immediate family for three years while her relatives and friends shunned her.

What other way is there to deal with the smell, right?

An untreated fistula can lead to infections, ulcerations and even death. Some women get nerve damage in their legs and can't even walk and end up needing physical therapy. Just to avoid leakage, women avoid drinking water and become dehydrated. But amazingly, there is a cure for repairing fistulas: a mere $300 to $400 surgery that has a high percentage success rate. But again, all because of a lack of resources, a surgery that seems so easily accessible is virtually impossible. $400, though it may seem like a lot, is absolutely nothing for a surgical procedure that could save a life and prevent a woman from being humiliated for the rest of her life.

A question that often comes up is how prevalent obstetric fistulas even are, considering that it's virtually unheard of in developed countries. The answer is simple--it's extremely common. Numbers shouldn't even matter (I think just looking at statistics is dehumanizing--everyone has their own unique story), but according to the Campaign to End Fistula, two million women remain untreated, with 50,000 to 100,000 new cases occurring each year. But it's hard to tell how many unreported cases there are.

Five years ago, I couldn't believe what I was seeing as I watched a video of scared girl standing in the corner, urine leaking from in between her legs and forming a puddle beneath her. Why should something like this be happening to a child? I was shocked and I am still trying to get a grasp on this. I don't feel like I can do any of these women's experiences justice with this blog, but I just hope that I can spread a little bit more awareness. To anyone interested in learning more about obstetric fistulas, The Fistula Foundation and Campaign to End Fistula are two great resources. More of Zegewhechu's story can be found here: Pathfinder International.

I'm not going to end with a proposal or a solution because 1) I don't have one and 2) that wasn't the intention of this post. My goal was simply to increase awareness about this condition. Considering it's such a devastating and serious issue, I'd like to hope that people won't just think "It sounds kinda dirty" when someone asks them what an obstetric fistula is:



Here's a final video on more about fistulas: