Across much of the developing world, women do not have access to family planning services or health care before, during or after pregnancy and childbirth.

Only 20% of married women in Sub-Saharan Africa are believed to be using contraceptives, as opposed to 50% in North Africa and the Middle East. Lack of information and choice lead to unwanted pregnancies, with terrible social and health consequences: dropping  out of school  early and multiple unwanted births contribute to the cycle of poverty and increase the risks of health complications such as haemorrhage and fistula.

For women who want to have a child this can be a life or death choice, which they will face alone and unsupported. In the Afar area of Ethiopia alone, there are over 2 million people without any obstetric services. Most of these women end up delivering babies in their villages, often in unsanitary conditions, with no medical attention whatsoever.

The result is that up to 1 in 22 women will die during pregnancy or childbirth.

The-Problem-1
Photo credit: Dr. Andrew Browning

Those who survive run the risk of carrying painful and life-threatening scars as a result of giving birth. It is estimated that for every women who dies during labour, around 30 women will suffer labour injury. The worst and most severe injury that a woman may get is an obstetric fistula. This occurs if the baby becomes stuck during labour, which happens to about 1 in 20 labours around the world. In the Global West, this situation is redressed by performing a caesarean section. But in lower income countries where there aren’t the hospitals or doctors to deliver help when needed, this can have catastrophic results.

Without a caesarean section, a woman may stay in labour for up to ten days. In most cases, she will die. If she does survive, it is highly unlikely that her baby will survive with her – so this terrible ordeal will nearly always result in a still birth.

Credit: Joni Kabana
Credit: Joni Kabana

For women who battle through the pain of drawn-out labour and mourning for their babies, they still have to overcome the consequences of this ordeal – which are life-long and devastating. Due to the extended period spent in labour, the tissues in the pelvis are compressed and eventually die, including those between the bladder, birth canal and rectum. As the dead tissues come away, they are left with fistulas, or holes, between the bladder, the rectum and the outside world. Without surgery, this will render them permanently incontinent.

Being unable to stop the constant leaking from bladder and bowel can have significant consequences to social and family life. In many cases, women affected by fistula face being divorced by their husbands, rejected by their families, and stigmatised by the communities they have grown up in.

The World Health Organisation estimates that around 99% of maternal deaths occur in developing countries, this equates to around 800 per day and a further 24,000 suffering life-long injury, including obstetric fistula. Millions more are already living with this condition.This needs to be stopped. Help us reduce their suffering and empower them to build a new future for themselves.