My name was mentioned by a colleague on Twitter a few days ago, giving a generous nod to me as well as the unparalleled Dr. Jen Gunter and the Women’s Health Foundation, for our work in advocacy and women’s healthcare. Unfortunately, it was in the sad context of her reading a recent report on a legacy of trauma inflicted on laboring mothers in Ireland in past generations, all in the name of medicine and ‘protecting the mother and unborn child’.
It struck me as timely as I was preparing to write a short piece of my own on global women’s and maternal health, particularly because as deserving of attention and justice are the Irish mothers injured in childbirth, so are the millions of women in low-resource countries and settings the world over. Women and girls are the most marginalized and disadvantaged citizens in the resource-poor world, particularly so amongst the rural, poor, and uneducated communities (1).
They often marry young, bear their children young, and do so with little or no access to obstetric medical care. The result of this low socioeconomic status is clear: Women die in childbirth in high numbers, and do so from causes that are largely preventable. Those that survive often bear an enormous burden of loss, disease and disability.
It is estimated that for every 1 woman who dies in childbirth, there are 20 who are living with one or more so-called maternal morbidities, a more broad term functioning as a catch-all for complications affecting mothers – both severe and more ‘minor’ – that are attributable to pregnancy and/or childbirth-related causes (3, 4). These complications include hemorrhage, sepsis, uterine rupture, obstructed labor, mental health disorders, and obstetric fistula (3).
Among the most devastating of maternal morbidities is obstetric fistula (OF), a condition defined as an abnormal anatomical communication, most frequently between the vagina and the bladder, the vagina and the rectum, or the vagina and both bladder and rectum. It results in constant leakage of urine and/or feces. Fistula due to obstetric complications is the most common cause of gynecologic fistula, affecting an estimated 50,000-100,000 women each year, and bearing a worldwide burden of 3.5 million women who are untreated (1).
It is most commonly the result of obstructed labor, where the fetus is effectively stuck in the birth canal. The mother lacks access to skilled emergency obstetric care and labor continues for days. The obstructed fetus impacts the soft tissue of the pelvis, causing the tissue to lose blood supply. Tissue death develops and a fistula is created.
The fetus does not survive and the now grieving mother is vulnerable to rejection, isolation and stigmatization within her community and family as a result of her odor, disability and inaccurate perceptions surrounding the cause of her condition.
Clearly, there is much to be done and innumerable ‘moving parts’ to address to improve the global health picture for women and mothers.
Fortunately, many individuals and organizations are working to advance maternal health and end fistula. Their approach includes improving access to skilled obstetric health care and prevention of unnecessary maternal death and disability, and improving the care of women with maternal morbidities. Consensus from the global health community is that the world is succeeding in keeping more mothers alive (aligned with the Millennium Development Goals set forth by the UN in 2000). However, the global burden of death and disability, secondary to pregnancy and childbirth, remains unacceptably high and is being borne by the world’s poorest.
Future posts will continue to explore and explain what is meant by “global health” in the context of women and mothers, and how it remains connected to the burdens so commonly associated with pregnancy and childbirth — urinary incontinence, fecal incontinence, pelvic pain, pelvic organ prolapse — even in our own resource-rich country
- Wall LL. Obstetric vesicovaginal fistula as an international public health problem. Lancet. 2006 Sep 30;368(9542):1201-9.
- Lozano R, Wang H, Foreman KJ, et al. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011 Sep 24;378(9797): 1139-65.
- Koblinsky M, Chowdhury ME, Moran A, Ronsmans C. Maternal Morbidity and Disability and Their Consequences: Neglected Agenda in Maternal Health. J Health Popul Nutr. 2012 Jun30(2):124-130.
- “Better Off Dead? A report on maternal morbidity from the UK All Party Parliamentary Group on Population, Development and Reproductive Health” May 2009.
Published On: July 11, 2014