Obstetric fistula A Women’s Health and Justice Issue in Ethiopia 1
Presented by: Bridget Straumann Made for Global Search for Justice in Women’s Health Issues At St. Catherine’s University 2010 2
3 Africa Ethiopia
Definition of terms What is an obstetric fistula?
An abnormal opening that develops connecting the vagina to other organs
The bladder, urethra, rectum or a combination
Symptoms are uncontrollable leaking of urine or feces
Due to prolonged labor
Duration of 2 or more days
Where the progress of labor is obstructed ~ blocked
A retrospective study of patients from Addis Ababa Fistula Hospital in Addis Ababa, Ethiopa 1210 women total No prior history of obstetric fistula 96% caused by obstructed labor > than 3 days 93% fetal outcomes were still-birth 6
It is a Women’s Health Issue
A physiological outcome specific to pregnancy and the birthing process
Lack of education
Inadequate health care
Cultural role of women
It is a Justice Issue Access to prenatal and obstetric care is limited Availability of skilled care and facilities to manage the birthing process is difficult to support The financial resources to sustain more medical care does not exist 8
Background Cultural role of women Labor intensive Agricultural lifestyle Low education Early Marriage < 16 years old Young Maternal Age < 16 years old Malnutrition in the country Inhibits height Smaller pelvis 9
Background Combination of factors contributes to:
Impeded blood flow to surrounding tissues*
Development of a fistula
* Arrows point to the stressed areas 10
Background Additional Contributing Factors: Inadequate health resources Lack of recognition that medical help is needed Limited transportation to medical facilities that are present in Ethiopia 11
Demographics Ethiopia 3rd highest population in Africa 89% rural living 47% of live below the poverty line Basis of economy: Rainfed Agriculture Exports: Coffee, Spices, Tea, Life expectancy 46 yrs 12
Inadequate transportation and roads Many languages are spoken throughout Ethiopia Average number of children per woman is 6.1 New law in place that limits foreign organizations and those that receive >10% of funding from participating in human-rights related work. 13
Daily Life: Ethiopian life is centered around religion, language and family. Food: -Protein: Beef, goat, lamb, chicken -Legumes and vegetables -Bread made of teff called Injera, served at every meal -Tea and Coffee For girls: -School is not deemed important for their role in the family and society at large -Expected to help in meal prep -Retrieve water from miles away everyday 14
Why obstetric fistulas persist: Cultural beliefs and customs devalue women Women are expected to marry early Begin having children soon after Obstetric care is given a low priority because women lack value in society Lack of preventative measures encourages early marriage and pregnancy Birth control is not taught in the school nor easily obtained 15
Preventable condition that robs women of their bodily integrity, forces them to live with a compromised physical condition
Socially the shame and loss of personal worth and intrinsic devaluation, loss of consortium
16 Why obstetric fistulas should not exist:
Current Actions UNFPA current global campaign to end obstetric fistula http://www.unfpa.org/public/home/mothers/pid/4386 Engender Health (Bill & Melinda Gates Foundation) – Fistula Care Project http://action.engenderhealth.org/p/dia/action/public/?action_KEY=6953 The Hamlin Fistula Hospital in Addis Ababa, run on charitable donations http://www.hamlinfistula.org/ 17
Questions by Farr:
Where are the women?
Women with obstetric fistulas remain silently in the background. The women mourn the loss of cultural connections that come from shared experiences.
Where is the Power?
Power resides with the men who ostracize the women who develop a obstetric fistula through no fault of their own.
Where do we stand?
Humbled by the wealth of resources we take for granted Thankful for the access we have to medical care Able to share, educate and bring awareness to others in an effort to affect change. 18
19 A hut built by a women to live in after being rejected by husband and family due to the obstetric fistula she had. PBS documentary: ‘A Walk to Beautiful’
Women affected experience: Powerlessness
Lost social/community opportunities
Physically compromised/without prospects for improvement
Often further traumatized by still birth
Useless to the community
Value reduced to nothing
Sources for Images: Girl with jug: http://chora.virtualave.net/ethiopian-girl.jpg Pregnant image: : http://www-stu.calvin.edu/chimes/issue_images/100/11/n4.jpg Birth diagram: http://www.fistulacare.org/pages/images/General/obstructed.jpg Fistula Hut: http://obgyn.duke.edu/modules/ob_about/index.php?id=4 Women carrying water: http://www.waterencyclopedia.com/Da-En/Developing-Countries-Issues-in.html Young girl carrying wood: http://www.ywamethiopia.com/about_ethiopia.php Ethiopian Highland Farm: http://search.eb.com/eb/art-123298. 22