For What We Have Done and for What We Have Failed To Do

"In the middle of the night

In the middle of nowhere,

I lie bleeding."

This is the voice of one of the thousands of women who die in pregnancy or childbirth in the developing world each year. The worldwide toll has been estimated to be as high as 600,000 maternal deaths annually. In the U.S., the risk of a mother dying during pregnancy and labor is 1 in 9,000. In Africa? 1 in 13.

Dr. R.L. Walley, medical director of MaterCare International and a professor of ob/gyn who has spent 20 years caring for poor mothers in West Africa, cites five causes for this unimaginably high level of maternal mortality: hemorrhage, infection, induced abortion, high blood pressure and obstructed labor.

"Maternal deaths do not take place in a visible and concentrated way, but occur among very young mothers, in small villages, and a few at a time. Most die in terror from haemorrhage or in agony from obstructed labor as their pelvises are too small" ( "The tragedy," Dr. Walley recently explained at a Vatican conference on women's health issues, "is that the solutions to this suffering have been known for decades and cost very little. Simply put, mothers in our world in the late 20th century are being neglected basically because motherhood is not of political importance" (Walley, "Maternal and Perinatal Care: A Preferential Option for Mothers," delivered in Rome, Feb.20, 1998). Although the medical conditions that might lead to maternal death "cannot always be predicted nor prevented, most of the deaths need not happen if complications receive prompt treatment. ... [The] women who die want to be mothers but are poor, young and have no influential voice to speak on their behalf and thus are denied the emergency care which is readily available and inexpensive. All that is needed is the will to do something significant" (Id.).

Nothing typifies the chasm between obstetrical care in the industrialized world and that in developing countries better than the "forgotten disease" known as obstetric fistula. It is a health, personal and social tragedy almost unknown in the developed world for the past 100 years.

Fistulae occur because of unrelieved obstructed labor. Because the bladder or rectum or both are trapped between the head of the baby and the bones of the pelvis, pressure necrosis results, which in turn leads to the fistulae or abnormal connections to the birth canal, which further results in the mother becoming incontinent. The mother leaks urine and faeces down her legs and thus is wet, filthy and foul smelling and is rejected by her husband, family and society. Tragically, she is also regarded as having been unfaithful to her husband and is condemned and ostracized. There are tens of thousands of these mothers who need loving care, through surgery, excellent nursing care, rehabilitation and counseling (Id.)

Instead, most of these mothers receive only a bowl which they carry between their legs. Some 500,000 to 1 million women, mostly in sub-Saharan Africa, suffer the consequences of obstetric fistulae.

Eradicating such a devastating condition should logically be a top priority of the UN-sponsored "Safe Motherhood Initiative" (SMI). Readers of Life Insight (see, e.g., the October 1997 issue) will remember, however, that SMI has little to do with safety, motherhood or letting women take initiatives. Dr. Walley has found that "almost $5 billion is spent on birth control programmes by aid agencies to reduce world fertility rates, but only a small fraction is spent on helping women survive their pregnancies" (Walley, op. cit).