Features Health

There is life after a fistula

DOREEN NAWA, Lusaka
FOR most Zambia’s rural populace, marrying off an adolescent girl is looked at in terms of monetary gains or indeed it being good riddance from the responsibility of looking after the girl.
For Jessy Chirwa, 19, because of extreme poverty in her community, she engaged herself into a relationship at 14 years.
Jessy was just 14 when she got pregnant. A community leader and father of two lured her into his room and impregnated her after giving her money. It was Jessy’s first sexual experience.
The man took responsibility of the pregnancy and accepted to marry her.
In a small village in Mumbwa, west side of Lusaka, Jessy, an orphan since the age of six, was left in the custody of her grandmother after the death of her parents.
In most rural areas countrywide, medical care is hard to come by, she carried her baby to full term.
When the time came for her to give birth, Jessy was at home by herself. Just several kilometres away was a medical centre but she was unable to reach it.
“My labour started around 03:00 hours. Because I was the younger wife, I could not walk from my house to go and wake up my husband who was sleeping at his senior wife’s house. It was after 10:00 hours that he showed up and I told him how I was feeling. He then took me to the nearest health centre.
“I didn’t have the bus fare to get to the nearest health care facility so we used an oxcart. When I got there, I was left unattended to for several hours too because the medical staff had gone to Lusaka to get their salaries,” Jessy said.
She was then rushed to Lusaka’s University Teaching Hospital where she underwent caesarean section just to remove the dead baby so as to save her life. She gave birth to a stillborn baby boy.
Such an intense labour, without medical assistance, placed strain on both her and the unborn baby.
Four days later, Jessy realised she was no longer able to control her bodily functions.
She couldn’t control her urine whenever she sat, walk or lying in bed. Her urine just leaked uncontrollably. She was later treated and went back to her village. Unfortunately, her husband divorced her because she could not give him a son.
The stigma attached to having fistula means women stand to lose a lot more than just their careers – partners and families often disown them because of the perception of uncleanliness, and the mistaken assumption that they’re suffering from venereal disease.
The condition is called obstetric fistula, a severe medical condition suffered by many African women, Zambia inclusive.
A study by World Bank has shown that in Zambia, girls aged between 15 to 19 who are sexually active, increased their chances of having fistula by more than 75 percent.
Obstetric fistula is both preventable and treatable, yet it still plagues the lives of many women living in poverty in developing countries.
With little reproductive health education or access to medical support, this relatively unknown and taboo condition regularly goes untreated, as women believe the symptoms are normal after giving birth.
It is now widely accepted that keeping girls in schools, especially, ensuring that they complete at least primary education, contributes to women empowerment, curtails harmful traditional practices such as child marriage, promotes gender equality and reduces incidences of maternal morbidity and mortality, including obstetric fistula.
In the past, the taboo nature of the condition prevented many sufferers from receiving the treatment they needed. But this is changing following commitment from Governments and various cooperating partners.
Minister of Gender and Child Development Nkandu Luo says poverty has contributed to the high number of adolescents getting pregnant, dropping out of school and early marriages.
Prof Luo said because of such vulnerability, adolescent girls aged between 10 and 19 have fallen prey to having sex early.
“Poverty has a female face and it’s worse among adolescent girls. The levels of poverty have led to these girls engaging in early sex resulting into not only dropping from school but also complications like fistula,” she said.
Prof Luo said child marriage can have devastating consequences for a girl’s health.
“Child marriage encourages the initiation of sexual activity at an age when girls’ bodies are still developing and when they know little about their sexual and reproductive health. Neither physically or emotionally ready to give birth, child brides face higher risks of death in childbirth and are particularly vulnerable to pregnancy-related injuries such as obstetric fistula,” Prof Luo said.
And World Bank country director Kundhavi Kadiresan said delaying early sexual debuts and reducing early marriages among adolescents will reduce and prevent chances of girls having Fistula.
Dr Kadiresan says it is extremely difficult for child brides to assert their wishes and needs to their usually older husbands, particularly when it comes to negotiating safe sexual practices and the use of family planning methods.
“When a girl marries as a child, the health of her children suffers too. The children of child brides are at substantially greater risk of perinatal infant mortality and morbidity, and stillbirths and newborn deaths are 50 percent higher in mothers younger than 20 years than in women who give birth later. There is little doubt that reducing child marriage will help to ensure more children survive into adulthood,” Dr Kadiresan said.
Dr Kadiresan said educating and providing employment opportunities to girls will reduce poverty among them.
“If girls attain high levels of education, this reduces or indeed delays their chances of getting married early. Opportunities to engage young women should be optimally utilised to enable mainstreaming of obstetric fistula messages into routine services such as antenatal and postnatal care services,” Dr Kadiresan said.
Dr Kadiresan said successful integration of family planning messages needs to be implemented with community based maternal health services such as antenatal and postnatal counselling services in rural areas countrywide.
Improving the health and wellbeing of adolescent girls and enabling them to avoid early marriage is a transformative way to improve maternal health around the world.

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