When I weigh the choice to have a child or not, and I imagine the possibility of having a baby, I always imagine myself in a hospital, with ice chips, and my husband by my side holding my hand, having nurses clean off the baby, and holding a healthy infant, safe and warm in a clean bed. I imagine having access to painkillers, medicine if needed, and someone to follow up in case of complications.
In developing countries, women who give birth often do so in huts, with dirt floors, with no painkillers, no ice chips, no sterile environment at all. Labor complications can occur with no one to help. If a woman can get to a hospital, often times she can't afford the medical care she needs, like a C-section, or antibiotics for infection.
And worst of all, particularly for extremely young mothers (under 20), there is the risk of developing a fistula. It's an ugly word, fistula. It's caused during obstructed labor and is basically a rip between the vagina and bladder and/or rectum, that leave the mother incontinent. Usually the baby dies, or is stillborn. The woman is then ostracized.
Here is a story from one such unlucky woman:
HALIMA GOUROUKOYE, 18, NIAMEY, NIGER
I was 13 years old when I was married to my husband and 14 when I developed fistula after a difficult birth.
It was an arranged marriage. I wasn't happy about it but my parents told me that he was a good man and that he would look after me. It's better than nothing.
I got pregnant after my very first period. I didn't understand what was happening with my body. I started to have little illnesses and the traditional medicine wasn't working so my husband told me to go to the clinic.
It was there that they told me that I was pregnant. My reaction was: "Oh God! I'm dead!".
When I returned home I was still ill all the time but I continued to do everything - I had to collect wood, prepare meals, clean the house and care for my husband as well as work in the fields. I had to do everything.
When the time came for me to give birth, I had two days of labour at home because in my culture it is preferred if you can give birth at home.
But it wasn't working so I went to a clinic. Labour continued and they said I would need a Caesarean section but the doctor sent me home because I couldn't afford the operation.
I had to wait for my family to collect the money to pay for the operation. Then we drove to Niamey which took a day. By that stage I had been in labour for days. I didn't know where I was, I was almost unconscious.
At Niamey they carried out the Caesarean. The baby died. He was a boy, I felt so sad.
Three days after the birth I realised that I could not hold in my urine. I was told to be patient but the leaking carried on for six days. They told me to go home and come back in two months.
We didn't tell my husband, we told him that I was ill and I went back to stay with my parents. We tried to hide it from everyone.
They thought I was cursed. I didn't want anyone in the village to know. I felt very isolated.
After two months we returned to Niamey to a non-governmental organisation which helped me.I had one operation and I was healed. I was delighted. Before, I was always crying but afterwards it was like I was reborn. Only now that I am healed does my husband know what happened to me.
Stories like this make me want to cry. Halima lived for months like that. If you click on the link, you can read another story, and the woman in that one suffered her fistula for 12 years. I've read worse stories in other places, including one of a 13 year old who suffered a rectal fistula and was left by her husband to die in a makeshift hut in the woods with no food and surrounded by wolves. It makes me sick to think that my cat Brooksie got better medical care for her cancer than these women do for the basic function of giving birth.
- Caused by prolonged labour
- Hole develops between vagina and rectum or bladder
- Renders women incontinent
- Occurs almost entirely in developing world
- Two million have the condition
- Up to 100,000 cases each year
- Operation costs £170 ($350)
Each year at the holidays, I make a donation to the Campaign to End Fistula. I encourage others to join me. It's a very simple operation in most cases, and there are so many women who need it.