Fighting Obstetric Fistula in Ethiopia


SEATTLE — Yeserash was between 12 and 13 years old when her father Simeneh arranged her marriage. He had 10 children and Yeserash was the oldest. According to her father, she had a happy childhood tending her family’s cattle. However, that all changed after Yeserash was taken out of school to get married. She soon became pregnant, and after a difficult labor suffered serious medical complications. The baby did not survive. Because of her child marriage and lack of access to medical aid, Yeserash became yet another victim of obstetric fistula in Ethiopia.

The Global Problem of Obstetric Fistula

Obstetric fistula affects about two million women around the world, with thousands of incidents being reported each year. According to the United Nations Population Fund, obstetric fistula “is a hole between the birth canal and bladder or rectum caused by prolonged, obstructed labor, without access to timely, high-quality medical treatment.” It causes the mother to chronically leak excrement, leaving her in constant pain and facing ostracization from the community. Obstetric fistula in Ethiopia affects at least 36,000 women, making it a concerning public health problem for the East African nation.

Obstetric fistula can also be a reminder of a painful loss. Babies often die from a lack of oxygen during prolonged labor, meaning fistula patients can experience deep grief along with the pain inherent to their condition. Combined with the social stigma of the disease, depression is common among fistula patients. Obstetric fistula in Ethiopia seriously harms women’s mental and physical health.

As she explained in a video produced by USAID, Yeserash experienced this trauma firsthand. Her thighs blistered from the urine running uncontrollably down her legs. She felt “lower” than the people around her because of her loss of control over her bodily functions. Social factors contributed to her sense of self-loathing. Simeneh reported that other villagers coming by the house would loudly complain about the smell of urine and even spit to show their disgust. Yeserash often felt hopeless and her father said that at points he wished he “wasn’t alive to see her pain”. Obstetric fistula took a toll on the whole family.

Ethiopian Government Introduces Initiative to Help Women and Babies

However, as serious as obstetric fistula is, Ethiopia has made great strides in combating it. In 2014, the government initiated a five-year campaign against obstetric fistula. NGOs support the government’s efforts to provide thousands of Ethiopian women with the obstetric healthcare they need. Chief among these organizations is the Hamlin Fistula Hospital, the global leader in fistula care, but there are many others carrying out the same mission. For instance, Aira Hospital provides free surgeries and transportation to its faculty. The historic University of Gondar has expanded its Fistula Training and Treatment Center. Specialized programs have even been designed to bring the same aid to the region’s refugees. Collectively, these organizations have served thousands of patients.

Yeserash’s treatment is one of these success stories. After learning about a hospital from a medical official, Yeserash was admitted and cured in a painless procedure. She regained her health, improved her social standing, and even gave birth to a baby boy. Her father said that after her procedure the whole family felt “boundless happiness”. She was cured.

However, as the adage goes, prevention is the best cure, and in the case of obstetric fistula in Ethiopia, there are two main factors that encourage the prevalence of the condition. First, lack of access to skilled personnel creates a serious threat to mothers and babies. Only 15.5 percent of births in Ethiopia are attended by trained medical staff and there is only one doctor specializing in female reproductive health for every 350,000 Ethiopians. This contributes to the nation’s high rate of maternal mortality (one in 64 women will die in childbirth over the course of her lifetime) and labor complications. Personnel who are trained in preventing prolonged labor can greatly reduce the risk of obstetric fistula.

Child Marriage a Factor in Obstetric Fistula in Ethiopia

The practice of child marriage also contributes to the prevalence of obstetric fistula in Ethiopia. According to course materials from the College of Medicine and Health Sciences at Hawassa University in Ethiopia, most fistula victims are young girls who live in impoverished rural communities. A World Health Organization study determined that out of all fistula victims in Nigeria and Ethiopia, half were pregnant when they were still minors and a quarter were pregnant when they were younger than 15. The average age of first marriage for 639 surveyed fistula patients at the Addis Ababa Fistula Hospital was 14.7 years old. Many of these young girls are simply not physically developed enough to go through childbirth, leaving them at risk for complications like obstetric fistula.

The Ethiopian government has worked to address the issue of child marriage. The legal age for marriage in Ethiopia (regardless of gender) is 18. Over the past decade alone, child marriage has gone from making up 60 percent of Ethiopian marriages to only 40 percent. However, cultural norms like bride abduction, female genital mutilation and cousin marriage have made child marriage difficult to stamp out, especially in traditionalist rural areas. Ultimately, attitudes need to be changed, not just the law.

Yeserash’s father Simeneh has made it his mission to counter social norms around child marriage. His daughter’s experiences with obstetric fistula in Ethiopia has changed his perspective on the practice. He advises his neighbors, “Don’t arrange an early marriage. Let the girl consent to marriage.” After seeing his daughter’s ordeal, he wants others to avoid his “painful mistake”. He also vowed that Yeserash’s sisters will not enter into child marriages. In the meantime, Yeserash is content with her family and young son. She comments, “Now, that I am back to my normal life, I am also elated.”

– Lydia Cardwell
Photo: Flickr


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