Cursed by God?

Americans generally think of pregnancy and birth in terms of natural processes that call for a healthy diet, doctor’s appointments, ultrasounds, and pain management during labor. But as New York Times columnist Nicholas D. Kristof reported February 25, giving birth can prove nothing short of disastrous for many women in Africa.

That’s because a large number of African women are stricken with obstetric fistula, a complication in childbirth that can leave the woman incontinent and socially isolated. With little recourse to corrective surgery, many of these women come to see themselves as cursed by God.

Obstetric fistula is the development of an abnormal body cavity that can allow uncontrolled leaking of urine and feces. For afflicted women, this can mean social ostracism and eventual abandonment. Their appearance, odor, and likely inability to bear more children can lead to their being shunned and to early death. While worldwide figures for postlabor fistula are hard to come by, partly because of the shame often associated with the condition, the United Nations Population Fund estimates that 2 million women live with the condition. There are a hundred thousand new cases each year.

In 2005, the World Health Organization (WHO) showcased a program called Great Expectations. Its aim was to draw attention to maternal-and-child health worldwide. It traced the lives of six women, from pregnancy through their infant’s birth and first year. The women were from Bolivia, Egypt, Ethiopia, Laos, India, and the United Kingdom, and they differed in age, wealth, marital circumstances, and number of previous pregnancies. But their pictures were beautiful and luminous, conveying the women’s struggles in pregnancy and their joy in their healthy newborns. The point was to underscore that women should be honored for carrying life and helped to do so safely.

International disparities in maternal morbidity and mortality make clear what a difficult undertaking motherhood can be. According to WHO, about half a million women die from pregnancy complications each year, and another 300 million experience short- or long-term problems related to pregnancy and childbirth.

Since the nineteenth century, obstetric fistula has become so rare in the West that it is almost unknown. As a result, it has dropped from our radar screen as a medical condition that merits public attention. This is unfortunate since it is comparatively easy and inexpensive to prevent or remedy. Dr. Catherine Hamlin, who runs fistula hospitals in Ethiopia, reckons that $450 covers the cost for repair surgery, “high-quality postoperative care, a new dress, and bus fare home.” The procedure can mean the difference between a return to normal life and ostracism or even death. At Hamlin’s hospitals, the success rate for the surgery is 93 percent.

Kristof faults the Bush administration for cutting spending on global maternal-and-child health programs. And Kristof is not alone. Supporters of population control and abortion have long lamented the reduction of international funds for reproductive health. But maternal-and-child health policy does not consist only of limiting or avoiding babies. Healthy pregnancy and childbirth should also be of interest to policymakers opposed to abortion and population control. Efforts to treat obstetric fistula need not be drawn into the abortion controversy.

As Kristof notes, though, neither Democrats nor Republicans have shown much interest in the problem. He credits the work of several organizations (most of them operating on shoestring budgets) like Hamlin’s Fistula Foundation. But he fails to mention MaterCare, an association of Catholic health professionals that has raised money, built clinics, trained traditional birth attendants, and served women with fistula since 1995. Founded by Robert L. Walley, a Canadian physician, it has chapters in several countries and sponsors major programs in Ghana, Kenya, and Rwanda. In Ghana, for example, MaterCare is overseeing construction of a forty-bed women’s-care facility. It engages in various types of assistance and advocacy, making critical connections between its prolife position and its practical aid to women. Unlike some international approaches to women’s issues, this program does not set motherhood at odds with women’s progress.

Those who pride themselves on their concern for babies and women should not forget the plight of millions of African women who suffer from a condition that is easily remedied. Left unassisted, their lives can seem “cursed by God.”

Published in the 2007-09-28 issue: 

Agnes R. Howard is lecturer in humanities at Valparaiso University in Valparaiso, Indiana.

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