Obstetric Fistula: A Legal Perspective, AFR (Halifax) Lions Club Speak-Out First Place Winner:

By Habiba Cooper Diallo


About 4 years ago, I was doing some online research on women’s health issues around the world, when a very compelling article in the Wall Street journal caught my attention. It headlined Anafghat Ayouba from Niger who was suffering an extremely tragic maternal health illness: obstetric fistula. 

It is important that you understand this issue well in order for you to fully grasp its severity and affliction. Obstetric fistula is a childbirth-driven illness that affects about 2 million women worldwide. But even that is a very crude estimate, being that it afflicts women in the world’s most remote regions, hence some researchers estimate it to be around 3.5 million. It results from a prolonged, obstructed labour in which there is no emergency medical care intervention, for example, a caesarean section (C-Section).

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The words “obstetric fistula” literally denote a hole between a woman’s birth canal and one or more of her internal organs.  The consequences of fistula are devastating. The child is usually stillborn and the mother is left incontinent, which means she has no control over her discharge of urine and feces. Due to this involuntary excretion of waste products from the bladder or rectum, and in severe cases both, she is abandoned by her husband, shunned by her family and neighbours, and forced to live a life of social exclusion. A number of fistula sufferers commit suicide, while others live in isolation with this debilitating illness until death, that is if they do not die as a result of it. The World Health Organization calls obstetric fistula “the most frightful affliction of humankind.”

So now I’ll return to Anafghat and expound upon the implications fistula had on her life.  She was determined to overcome the illness and continue with her studies, for she wanted to study medicine and live in Niger’s capital Niamey. And she did indeed triumph when her fistula was cured at the National Hospital of Niamey. Upon her return to her hometown Tarbiyat, she educated her whole community on the dangers of early marriage and childhood pregnancy; she became the paradigm of female empowerment. 

Sadly in 2007, about two years following her treatment, she died as a result of complications of an infection. Despite that however, Anafghat has left behind her legacy of strength, courage, and perseverance. “I want to be a doctor, and an important woman,” is what Anafghat told her father as she persisted through the illness. 

Recently, I had the privilege of visiting the Addis Ababa Fistula Hospital in Ethiopia with my family in January, where I had the most humbling opportunity to meet with and interview two fistula patients of my own age— Emewedat, 15 and Asris, 18. Their stories and experiences were telling. Similar to Anafghat, what struck me most in meeting these two young women was their courage and their hopeful spirit. It was then that my connection to and my work on this issue became more personal. 

To further contextualize obstetric fistula, it is important to note that it is a poor woman’s disease. When we take an analytical look at the women affected by it around the world, we see that incidences of fistula are high in parts of the nonindustrial world where women experience extreme poverty. Hence, it is not enough to understand and assess this issue solely on pathological grounds. This is a very multidimensional problem and we therefore must also take into account the socioeconomic and political factors related to the disease. 

There are three primary factors that contribute to fistula: 1. Lack of immediate intervention during an obstructed labour 2. Unawareness among communities about the potential consequences of early pregnancy 3. Inadequate, or sheer lack of education around the availability of treatment, or how to access treatment. (all of these factors evolve as a result of poverty.) And although 2, or 3.5 million obstetric fistula patients may not seem staggering in contrast to other maternal health cases like haemorrhage or eclampsia, one woman is one too many, especially when this disease is easily eradicable by something as feasible as a caesarean section, which is free here in Canada. The United Nations, legislators, and people all over the world, agree that basic healthcare is a right of all individuals on the planet. Article 25 of the Universal Declaration of Human Rights states that:

            (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

            (2) Motherhood and childhood are entitled to special care and assistance.

From a legal standpoint, obstetric fistula is a crime against humanity. Thus, governments must develop a mandate that supports it to be eradicated and actually implement the protocols necessary for this to be a reality. I must also acknowledge the efforts of some countries, such as Niger and Ethiopia, to see obstetric fistula effaced from the maternal healthcare realm. That being said, however, bear in mind that more work needs to be done. That’s where my voice and my message become relevant. It is in this message that I appeal to you to join me in fortifying the efforts to eradicate fistula, so that women and girls like Anafghat, Emewedat, and Asris can realize their dreams. 

So what we must ask ourselves is why are some lives more valued than others? Why is it that an impoverished woman living in the Agadez region of Niger cannot access emergency medical care when her labour is obstructed, but that a woman living in the province Nova Scotia, regardless of her socioeconomic status, can have a successful childbirth despite labour complications?


Links:

http://www.wsj.com/articles/SB111861500738457432