NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Drip, drip drip. This isn’t a loose pipe… its your body. Try as you might, you can’t stop the urine and feces from dripping down your legs.

With your private parts torn apart, likely as a result of childbirth gone bad, you now have a steady stream of human waste trickling out of you. You have a fistula. Just the very word makes me cringe.

In the days following Mother’s Day I’ve reflected on how excited my own mother was to receive an unexpected call from me. Throughout the world moms were celebrated by their families, but not all.

In some cases, mothers have thanklessly endured far worse pain than childbirth only to be shunned and left in misery. It is time that fistulas became a featured part of the anti-poverty conversation.

Martin Luther King famously wrote, “An injustice anywhere is a threat to justice everywhere…” and I would argue that indifference to curable suffering is an injustice.

Nicholas Kristof writes openly about fistulas in the book Half The Sky and in his NYT column he tells the heartbreaking story of one patient in the article “They Think They’ve Been Cursed by God”. The quotes in the remainder of this post can be credited to him. He writes: “There is also a milder, more diffuse cruelty of indifference, and it is global indifference that leaves some 3 million women and girls incontinent…Fistulas are common in the developing world but are overwhelmingly caused not by rape but by obstructed labor and lack of medical care during childbirth. Most of the time, such women don’t get any surgical help to repair their fistulas, because maternal health and childbirth injuries are rarely a priority.”

A Small Tear, But Not a Small Issue

Fistulas caused by obsetric labor have long since disappeared in wealthy countries, but the poor still suffer. “The World Health Organization estimates that 536,000 women perished in pregnancy or childbirth in 2005, a toll that has barely budged in thirty years. Child mortality has plunged, longevity has increased, but childbirth remains almost as deadly as ever, with one maternal death every minute. Some 99 percent of those deaths occur in poor countries.”

To put this in perspective, more women die per year in childbirth – nearly by a factor of 5 – than the estimated total number of civilian causalities over the last ten years in Iraq and Afghanistan combined. And we’re just talking about deaths … life may be even worse for those that survive.

It’s Much More Than a Leaky Faucet

For the women who manage to live to tell the tale of their blocked labor – and to smell the resulting fistula – often face more challenges when they head home. “The Fistula patient is the modern-day leper,” notes Ruth Kennedy.

The real tragedy is that in countries where fistulas are still common, the cultural divide at home places the women’s needs at the bottom of the totem pole. “Instead of receiving treatment, these young women-often just girls of fifteen or sixteen-typically find their lives effectively over. They are divorced from their husbands and, because they emit a terrible odor from their wastes, are often forced to live in a hut by themselves on the edge of the village…Eventually, they starve to death or die of an infection that progresses along the birth canal.”

Overcoming the Issue

Fistulas themselves aren’t impossible to treat or prevent. “Fistulas used to be common in the West … now almost no woman in the rich world spends four days in obstructed labor-long before then, doctors give her a C-section.”

There are essentially two reasons that fistulas persist:

1. Access to affordable treatment is rare:
The hero of fistulas is Catherine Hamlin, who founded the Addis Ababa Fistula Hospital in Ethiopia. Still, “It costs about $300 to repair a fistula, and about 90 percent of them are repairable. But the vast majority of women who suffer fistulas are impoverished peasants who are never taken to a doctor and never receive medical assistance.”

2. Cultural barriers restrict women:

As described in Half The Sky, women are often given second shrift in developing economies. Unfortunately this means that when all they really need is a human plumber to fix their insides, they receive resentment in its place. Rather than support them, their communities ostracize them. (Maybe its cheaper that way).

It’s not easy to make affordable treatment conveniently available to all mothers and its probably even harder to change cultural tendencies, but waiting will not solve anything either. It is time that this issue got some more spotlight & publicity. Tell your friends, and your mothers.

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