Poor Women in Remote Villages Cut Off from Medical Care Suffer in Difficult Childbirths


Erin Anastasi, United Nations Population Fund panelist. / UNFPA/Lothar Mikulla

The rural district of Msinga, South Africa is surrounded by over 1,800 kilometers of broken cliffs and hidden valleys. Of the 189,578 people who live in Msinga, over 100,000 are women. The impoverished town is geographically isolated from advanced health care services in urban areas and has the lowest levels of basic services of all the cities and towns within the district.

In Msinga, like many other places in sub-Saharan Africa and Asia, fewer than six in 10 women give birth with any trained professional, such as a midwife or doctor in attendance. When complications arise, no one is there to help treat the woman, leading to injuries like fistula or even death.

Obstetric fistula, a condition that has been largely eliminated in industrialized countries, affects 2 to 3 million women in developing countries, according to the United Nations Population Fund. Fistula develops after several days of prolonged obstructed labor when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to vital tissues in the region and results in holes in the mother’s bowels or the urethra, according to the Fistula Foundation.

Thandiwe Madondo, who is from Msinga and has witnessed fistula impact women in the district, said it can take hours to travel to a hospital and the closest emergency room is over 24 kilometers away.

“There is no transportation or ambulance,” she said. “Pregnant women are always being told that it’s too late once they get to the hospital.”

In areas where fistula is prevalent and transportation is inaccessible, women living in remote villages are forced to walk to the closest medical facility when they’re in labor. Fistula is preventable only if the women are provided with timely obstetric care. Once a fistula has developed, however, the only cure is surgery. The problem is concentrated in sub-Saharan Africa where births to teenage mothers account for more than half of all births, poor rural areas lack basic health care, and traditional home birth is common. Fistula can be prevented by delaying the age of first pregnancy, the end of harmful traditional practices, and timely access to obstetric care.

In a side event called “How Effective Partnerships in Healthcare and Education are Transforming Lives” at the annual Commission on the Status of Women conference last month, a panel discussed how grassroots organizations, life skills, vocational training, and critical health care services can help empower marginalized women in sub-Saharan African countries. Members from the United Nations Population Fund, Trickle Up, Keep a Child Alive, the Floating Hospital, and the Fistula Foundation-Nigeria also participated in the event.

The panel discussed how the root causes of fistula are poverty and the subordinate status of women and girls. In developing countries, poverty and malnutrition in children can result in stunting, where the girl’s skeleton, including the pelvis, does not fully mature and can lead to fistula during labor, according to the Fistula Foundation.

“There are stereotypes in our culture that women don’t have to go out to work and should stay home,” Madondo said. “Women are told to keep quiet.”

Women also feel too afraid to seek help for fistula at a hospital and instead go to village elders and healers who provide home remedies. The women are then told that they are “cursed” if the treatment doesn’t work.

The Fistula Foundation, an organization that raises money to train doctors and provide transportation in 30 developing countries where fistula is prevalent, holds radio sessions and sends outreach workers from hospitals to remote villages to educate women about fistula.

“It has to do with lack of education and literacy rates,” said Steven Armstrong, the communications assistant at the Fistula Foundation. “We have fistula ambassadors who are women who have been treated successfully and go back to villages where they came from to educate others that fistula can be treated. The ambassadors are huge in telling women that it’s better to go to a hospital and even if the fistula is untreatable, they can still go on to live a healthy and prosperous life.”

South Africa also has the biggest HIV epidemic in the world, with an estimated 7 million people living with HIV in 2015 and 380,000 new HIV infections every year, according to data from Avert HIV and AIDS.

“Not many people can accept that they have HIV,” said Madondo. “If a person knows going to the hospital will save their life, they’ll do it. Some people believe that traditional healers can help them better than the doctors.”

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