“The Impact of Obstetric Fistulas on Economic Empowerment” was the title of a topic dissected by a unique panel discussion held 3 March 2008 in New York City. The medical and socioeconomic impact of obstetric fistulas was considered under the auspices of the United Nations Commission of the Status of Women, with the co-sponsorship of the IHEU-Appignani Center for Bioethics.
The packed lunchtime meeting at Church Center, 777 United Nations Plaza, was standing room only. The discussion was closely monitored by more than 70 women from all over the world, many representing NGOs whose missions include advocacy in women’s rights as well as formulating concrete policies to promote gender equality and the advancement of women worldwide. Others in attendance were UN staff and other interested professionals from New York and environs.
The subject was one of many being considered at United Nations Headquarters by The Commission on the Status of Women (CSW), which held its 52nd session from 25 February to 7 March 2008.
This year the Commission focused on ‘Financing for Gender Equality and the Empowerment of Women’. The CSW is a commission of the United Nations Economic and Social Council (ECOSOC), which commits itself exclusively to gender equality and the advancement of women. It is also considered to be the principal global policy-making body. The Commission was established by ECOSOC resolution 11(II) of 21 June 1946 with the aim of preparing recommendations and reports to the Council on promoting women’s rights in fields political, economic, civil, social and educational.
Child marriage and obstetric fistulas
Despite international agreements and national laws, child marriage remains common custom in the developing world. Nevertheless, it is a legislated human rights violation that prevents girls from becoming educated, maturing, enjoying a healthy life, and, ultimately, choosing their own life partners. Driven mainly by poverty, child marriage has immediate and long-term health consequences, among them increased risk for sexually transmitted diseases such as HIV/AIDS and for cervical cancer. In addition, besides the incidence of obstetric fistulas, malaria and death during childbirth are other serious health consequences often resulting from premature marriage.
A high percentage of what amounts to children delivering children is found in the African nations of Ethiopia (25%), Uganda (42%), and Mali (45%). These girls give birth by age 18 compared with only 1% in Germany, 2% in France, and 10% in the United States. “Compared with women of 20 years of age, girls 10–14 … are 5 to 7 times more likely to die from childbirth, and girls 15–19 years of age are twice as likely For example, in Mali, the maternal mortality rate for girls aged 15–19 is 178 per 100,000 live births and for women aged 20–34, only 32 per 100,000”.
Among the reasons for these high death rates is obstructed labor, which is the consequence of the girl’s pelvis being too small to deliver a fetus. In effect, the shoulders of the fetus cannot fit through the mother’s pelvic bones, although its head passes into the vagina. Without a cesarean section, the neonate dies while the mother survives. Many times, obstructed labor leads to fistulas. The explanation is the pressure of the fetus’s head on the vaginal wall, causing tissue necrosis, and then the development of fistulas.
Obstetric fistula is a serious medical condition occurring after childbirth in which an aberrant communication develops between vagina and another organ – usually either the rectum or bladder – which may result in leakage of urine, feces, and blood. Obstetric fistulas affect women of all ages and account for 8 percent of maternal deaths worldwide. In many countries, particularly in the developing world, obstetric fistulas are accompanied by social and cultural stigmatization.
In western countries, obstetric fistulas were eradicated at the end of the 19th century when cesarean section became widely available. According to the United Nations Population Fund (UNFPA), more than 2 million adolescents are living with fistulas; fistulas develop in more than 100,000 adolescents every year. The World Health Organization has called fistula, “the single most dramatic aftermath of neglected childbirth.” Girls ages 10 to 15 years are especially vulnerable because their pelvic bones are unready for childbearing and delivery. Their risk for fistula is as high as 88%. Unless the fistula is surgically repaired, a fistula victim may suffer from psychological damage, loss of status, and loss of dignity.
A video clip from “A Walk to Beautiful”, the recent award-winning documentary directed by Mary Olive Smith, was screened during the panel discussion. Ms. Smith was also among the keynote speakers. The compelling documentary depicts the ostracism experienced of five Ethiopian mothers who are suffering from childbirth injuries. The film details how these very young women – girls, really – are relegated to being modern-day lepers, objects of stigma in isolation from both family and community. Following a group of such women to the special clinic in Addis Ababa, the documentary profiles 5 such children of poverty and prejudice who developed an obstetric fistula after obstructed deliveries. Despite her devastating childbirth injury, each makes the difficult journey to reclaim her misplaced dignity. The trials they endure, and their nascent attempts to rebuild their lives after being medically cured, reflect powerfully uplifting stories of hope, determination, courage, and, ultimately, transformation into rebirth.
Now officially designated a violation of human rights, child marriage has far-reaching health, social, economic, and political implications for the girls and their respective communities. It cuts tragically short girls’ childhoods as well as creates countless physical and psychological health risks. Eradicating child marriage, however, appears far too optimistic a goal since child marriage requires the consent of all those involved, including fathers, religious communities and tribal leaders. Needless to state, the consent is still given. Too, lack of enforcement renders international laws against child marriage ineffective. This fact was transparent throughout the panel discussion.
Some of the panelists, as well as members of the audience – especially those coming from countries in Africa – pointed out the importance of media campaigns and educational outreach programs to raise awareness of this particular issue. Despite these efforts, they too seem insufficient for eradicating child marriage. Unfortunately, some governments in the developing countries do not take responsibility for stopping this practice. Still, the labyrinth of learning about reproductive and sexual health, sexual transmitted diseases (STD) prevention, contraception, AIDS, and how to seek health care really does help girls negotiate safer sex. Preventive and treatment programs for reproductive health issues need to be incorporated by governments into their health services.
In a final analysis, ending child marriage and its dreadful consequences require a multifaceted approach focused on girls, their families, their communities, and, equally, their governments. Culturally sensitive programs providing families and communities with education and reproductive health services, can help end child marriage, with its attendant early pregnancies, illness and death in young mothers and their children.
Ana Lita PhD is Director of the IHEU-Appignani Center for Bioethics
The IHEU – Appignani Center for Bioethics, a project of the IHEU, supports endeavors dedicated to preventive medicine and seeks partnerships with health care professionals and other NGOs to provide educational venues and opportunities for confronting medical issues facing developing world countries. The panel discussion organized on 3 March 2008 complements the work of the IHEU’s ongoing campaign against child marriage. In collaboration with the World Population Foundation, the international Humanist and Ethical Union, IHEU has launched a joint campaign against the horror and injustice of child marriage, a practice all too prevalent in many parts of the world, and likely to affect over 100 million girls within the next ten years.