The Common Good

Bringing Fistula into the Light: International Day to End Obstetric Fistula

“An obstetric fistula,” I said, standing in the pulpit of my 200-year old church, “is a hole between a woman’s vagina and her bowel, or between her vagina and her bladder.”

Via Wikimedia Commons.
Patients at the Addis Ababa Fistula Hospital in Ethiopia are all treated free of charge, copyright: WHO/P. Virot, Via Wikimedia

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The congregation’s discomfort was palpable. Later someone told me that they couldn’t believe that I’d had the nerve to say the “v-word” twice!  It wasn’t exactly the effect I’d hoped to have, but it wasn’t entirely surprising.

Fistula is a childbirth injury that’s unknown today in the developed West, though before the advent of modern maternity care, it affected women — especially poor women — in America as well as Europe. It was likely the reason, at least in some cases, for a woman being euphemistically spoken or written of as an ‘invalid,’ or as having been ‘invalided’ by the birth of a child. Fistula’s story has always been one of (usually secret) suffering; even the surgery to repair the injury, developed by American gynecologist J. Marion Sims in 1840s Alabama, was performed experimentally upon slaves that Sims purchased for the express purpose of perfecting his technique before turning to white patients.

It’s women of color who still all but exclusively suffer fistula’s life-destroying effects.

Fistula happens when a baby gets stuck while being born, often because a girl is either underage, has a pelvic deformity, or has had her genitals deformed by female genital cutting — and there’s no trained person to help. She’ll labor for days without success. Only after the baby is dead and partially softened does it slip out from the exhausted mother, whose suffering has only begun. Days of pressure from the baby’s head have killed blood vessels in her vaginal tissues, which now decay, leaving a hole — or holes — from which urine and feces leak. She has become incontinent. Her husband divorces her. Her family makes her leave the house because of her stench. She can’t even keep herself clean enough, because the water she walks some distance to collect each day is just enough for basic use. The village children mock her for her stench; her neighbors ignore her.

Her story is multiplied between 50,000 to 100,000 times each year.

This is obstetric fistula: a childbirth injury many people can’t even name, whether from ignorance or embarrassment. The U.N. estimates that more than 2 million women living in Asia and Sub-Saharan Africa suffer untreated fistula.

I first learned of fistula from a New York Times column by Nicholas Kristof, whose book Half the Sky later brought the issue to the attention of many. Not long after reading that book, I watched the documentary A Walk to Beautiful, which chronicles the journey of women in villages of Ethiopia who managed to make their way to the fistula hospital in Addis Ababa, the hospital founded by Christian couple Reg and Catherine Hamilton, both OB/GYNs, who’d spent most of their lives dedicated to helping some of the most invisible and rejected women on the planet. I then did two things: purchased and read Catherine’s autobiography — The Hospital By The River — and signed up for doula training. I wasn’t about to become a medical professional, but I wanted to understand all that I could about the issues involved.

Two years later, I took a tour of the various women’s health units in Zomba Central Hospital, which is about a three-mile walk from where I live here in Malawi.

“That bed, over there, that one is reserved for VVF patients,” said Mrs. Mponda, the experienced midwife who was showing me around. She looked at me with a wry smile, “Do you know this, VVF?”

When I said yes — VVF being the abbreviation for vesico-vaginal fistula — she seemed a little surprised. And so was I, actually. “They’re performing fistula repairs here?” I asked.

“Oh yes,” she said, casually gesturing toward the empty bed. “Someone just went home. Healed.”

I felt that I was standing on holy ground.

Today marks the first International Day to End Obstetric Fistula, recently designated so by the U.N. General Assembly. A world where fistula is as rare everywhere as it now is in the developed world is possible. Raising the age of marriage, ending female genital cutting, improving childhood nutrition, and increasing the number of trained birth professionals — and providing access to surgeons skilled in fistula repair — are all part of the solution. But there must also be the political will and the humanitarian drive to identify the problem and direct resources toward (often complex) solutions.

In the 2nd-century apocryphal Gospel known as the Protoevangelium of St. James, Jesus’ birth happens this way:

“A great light appeared in the cave so that our eyes could not endure it. And by little and little that light withdrew itself until the young child appeared.”

No pain, no blood — much less urine or feces or, heaven forbid, a vagina — in this birth story; Jesus simply appears after an overwhelming light recedes, giving rise to the catechism of the Council of Trent, which has Jesus simply appearing, miraculously, outside Mary’s womb “without opening the passage.”

I reject this version most strongly. Jesus did not come to this earth as an incorporeal beam of light; he came into this world the way we all do — through the sacrificial suffering of a woman — to suffer with us, to give his very life for our healing. Fearing to name these earthier aspects of our being only perpetuates the secrecy, shame, and suffering.

It’s time to bring fistula into the light.

Rachel Marie Stone is the author of Eat with Joy: Redeeming God's Gift of Food (InterVarsity Press, March 2013) and a regular contributor to Christianity Today's her.meneutics blog. She has contributed to Christianity Today, The Christian Century, Books & Culture, Flourish, and The Huffington Post, among other publications. She blogs at RachelMarieStone.com and lives in Malawi, Africa, where she teaches English at Zomba Theological College.

Image: Patients at the Addis Ababa Fistula Hospital in Ethiopia are all treated free of charge, copyright: WHO/P. Virot, Via Wikimedia Commons.

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