If you were to ask teens in a sex education class about childbirth in America, most would agree that it is a relatively safe and easy procedure with practically no side effects. But childbirth is not nearly as risk-free in other places, especially in Ethiopia, Tanzania, and other countries in sub-Saharan Africa.
A devastating factor called an obstetric fistula can wreak havoc on young and adult women who give birth in poor, rural countries that lack doctors and nurses, sanitary facilities, roads, and methods of transportation.
A recent article in Science Times provides an excellent explanation of an obstetric fistula. Times reporter Denise Grady describes how a fistula develops after women experience complications during childbirth: “Obstructed labor can kill the mother [and baby] or crush her bladder, uterus, and vagina between her pelvic bones and the baby’s skull. The injured tissue dies, leaving a fistula: a hole that lets urine stream out constantly through the vagina. In some cases, the rectum is damaged and the stool leaks out.”
Young girls ages 13 to 17 are most vulnerable to obstetric fistulas. They are often married off soon after their first menstrual period, usually to older men in the community, and because of poor diet and nutrition, their bodies and bones are not strong enough to withstand normal labor. Exacerbating the problem, most of these young women live in rural areas—miles, hours, and even days from an urban medical clinic or hospital—and there is no transportation other than dusty carts and ancient buses to take them where they can have a safe delivery. There is no help when these women go into prolonged labor. The baby usually dies in their uterus and they develop fistulas.
Unless the fistulas are repaired by skilled surgeons, these young women leak urine and feces through their fistulas, some continuously. Most are ostracized from their homes and villages and often forced to live in huts they have made themselves. If married, their husbands usually leave them to marry another woman.
The only consolation to this terrible problem is that the operation to close the fistula is 90-percent effective. Grady reports that a charitable group—the African Medical and Research Foundation—brings skilled surgeons to Dodoma, Tanzania, to operate and train doctors and nurses from other places in Africa on how to repair fistulas.
But the person who’s done the most to shed light on the fistula/childbirth problem, and to bring help to young African woman, is 83-year-old Australian obstetrician/gynecologist Dr. Catherine Hamlin. She and her late husband, Reginald, also a surgeon, emigrated from Australia to Ethiopia more than 45 years ago to start a school of midwifery. Instead, after seeing the fistula problem, they pioneered the first operation to repair them and opened the first and only world center dedicated to providing free fistula repair, the Addis Ababa Fistula Hospital.
Hamlin tells the story of founding the hospital and the Fistula Foundation, which raises funds to support and expand its work, in her book The Hospital by the River.
The Fistula Foundation released a DVD, A Walk to Beautiful, that is tailor-made for high-school classroom use. This unforgettable film runs over an hour and is divided into six sections, which makes it very appropriate for classroom viewing and discussion. (We will give away a free copy of the video to the first five educators who comment on this post!)
Why should we talk about the problem of obstetric fistula among African women in our classrooms? Studying childbirth in places like sub-Saharan Africa might make our students more appreciative of the great progress we’ve made in medicine in the U.S. Some may become more understanding of international health problems, more empathetic about the needs of teens in poorer parts of the world, and more willing to contribute to others’ well being.
A high school health class might decide to hold a car wash or bake sale to raise funds for Addis Ababa Fistula Hospital. A student might be so inspired by the film that he or she might become an ob-gyn and spend a part of his or her life repairing fistulas and educating young women about their dangers in one of Dr. Hamlin’s hospitals.
Now that indeed would be beautiful.