Showing posts with label Maternal Mortality. Show all posts
Showing posts with label Maternal Mortality. Show all posts

10 November 2008

The Land of Sewn Women: Ending Female Genital Mutilation

In this week's post I decided to follow-up on my previous entry regarding maternal mortality by addressing one of its contributing factors: female genital mutilation (FGM). This practice, which is prevalent across Africa, may seem like old news to those who are aware of African issues and culture, but to the estimated 8,129 girls it will affect today, it is a very real and terrifying future. The United Nations expects three million women and girls will undergo the tradition each year, and estimates 100 to 140 million females have already had the brutal procedure. To give some perspective, that is about four to five times the entire population of Kenya, or both Germany and France combined! Since the 1970's, nongovernmental organizations (NGOs) and countries outside the continent have called for an end to FGM, and while a few African countries now have laws prohibiting the act, which shows a step in the right direction, most governments continue to allow it. Even where there is legislation against it, the mutilation still exists, proving laws are not enough! Because ending FGM means "changing the very fabric of African social tradition," campaigns against the practice must have the support of the government, but should also have a long-term educational component taught by fellow Africans who are sensitive to and understanding of the culture but condemn this harm against women. It is my belief that this community outreach and education approach will be the most effective at eradicating this injustice and protecting the health and lives of women throughout the continent.

There are several different forms of FGM including clitoridectomy, excisions and infibulations. The first is the least invasive and the rarest and involves the removal of the clitoral hood. Excisions, the removing of the clitoris and labia minora, account for about eighty-five percent of circumcisions, according to a publication by the Wallace Global Fund (WGF). The most severe and health-damaging form of mutilation is infibulations, which are the excision and removal of the labia majora, and then the stitching together of the two sides. The result is a smooth seal with only a small opening to allow urination and menstruation. A report by the Commissioner for Human Rights found that in some cases, "the artificial opening is sometimes no larger than the head of a match," and this practice is so prevalent in areas like Somaliland that anthropologists call it "the land of sewn women." In some countries, Amnesty International cites that ninety-eight percent of women have undergone infibulation. The statistics in other countries are generally around fifty to ninety percent of women who have had any of the three forms of cutting. Pictured below is the aftermath of a ceremonial mutilation, which generally takes place in the bush or other non-clinical and unsanitary settings, and is usually done with no anesthesia by a female elder. What is worse, the circumcision instruments are often unsterilized and may be anything from a knife, razor or scissors to broken glass.

The risk of excessive bleeding, infection, shock, infertility and death during childbirth of both the mother and child, is increased dramatically, a serious problem pointed out by Edna Adan Ismail, a medical worker mentioned in my last post, who listed FGM as one of the six main causes of maternal mortality. She reported that ninety-seven percent of women at her prenatal clinic have some form of mutilation. This does not even take into account the psychological consequences incurred. For what purpose are females subjected to such harm? In many African cultures women who are uncircumcised are considered "unclean" and therefore "unmarriageable outcasts" says the report by WGF, which additionally explains that the mutilation is also believed to protect a woman from illnesses, assure fertility and safe childbirth, and is used as proof of virginity and prevention of rape. In reality, FGM accomplishes the opposite of the traditional beliefs. It makes women less clean by making hygiene difficult during urination or menstruation, as females often have infections or hematocolpos due to the build up of urine or menstrual blood when it is difficult for the fluids to pass through the small opening. Therefore the cutting does not protect them from illness, but rather subjects them to it. The procedure can also make a woman infertile, cause serious complications during childbirth, and does not necessarily prevent rape. Consequently, the only purpose it serves is to prove virginity, which shows the custom has no practical use but rather preserves tradition and women's subordination to men. Because of these damaging effects it has on females, FGM needs to be stopped.

Some African governments, such as Eritrea and part of Uganda have outlawed the genital cutting of girls, punishable with a fine and imprisonment. Kapchorwa, the district of Uganda that banned the act, has requested that the law be enacted nationwide. Obviously some progress has been made, but there are still over twenty countries that are yet to create similar legislation, and even if or when they do, I agree with UN agencies that say "traditions are often stronger than law and legal action by itself is not enough to tackle this." Others who have been taking action against the practice are nonprofits, NGOs and the few women who have survived the mutilation and are brave enough to speak up. These groups have succeeded in bringing the topic of FGM into the world conversation and have made its discussion less taboo, and may have some impact on lessening the practice, but they themselves are not powerful enough to affect significant change in the culture and customs of the continent the way a local African leader or group could. The image to the right shows local women speaking out against female cutting, they are the genuine voices that should be heard in order to stop the practice. International organizations do not have the credibility or cultural insight necessary to gain the trust and following of these people who are often suspicious of the outsider's motives and ways. The report, Eradicating Female Genital Mutilation: Lessons for Donors, supports this idea by stating that, "projects are most effective when initiated and carried out by in-country activists whose occupation and high status give them credibility within communities." The best people for this position would be local leaders (both religious and traditional), African aid workers, teachers, nurses and other medical personnel. Some villages in West Africa have already started this process, by joining together to discuss and abolish FGM, according to BBC News. If this trend continues, we have a real chance of stopping this dangerous mutilation of women and girls. Governments can create laws and NGOs can attempt to convince people to change their ways, but it is my belief that when African governments enact legislation protecting women from genital cutting, combined with education and community outreach programs led by fellow Africans rather than outside organizations, areas that perform female mutilation will begin to alter their opinions and act against this harmful custom. It may take years or even decades to create significant change, but ultimately this approach is the most likely way we can succeed in protecting future generations of women from the pain and trauma of FGM.

02 November 2008

Where Pregnancy May Be Life or Death: Maternal Mortality in Africa

Everyday E! News or US Weekly seems to be reporting on a new pregnant celebrity and what she is craving, how she is preparing the nursery or how she plans to get that "pre-baby body" back. Expectant women in the U.S. have the normal fears that a mother would have; will the baby be healthy? Will I know how to do everything right? Do I have a good doctor? But in Africa, pregnancy is much more frightening. On the continent where there is a general lack of health care, (especially for women and children), death is a realistic concern when it comes to giving birth. This specifically caught my attention when the Washington Post wrote an article in October that followed a Sierra Leone woman through her life-threatening delivery and resulting stillbirth. When browsing the internet this week, I realized this sad circumstance has also caught the attention of other bloggers who are upset that these preventable deaths occur. The first blog I encountered, RH Reality Check, has a post written by Edna Adan Ismail, a lady involved in the medical field in Somaliland. Her entry, titled, "On Maternal Mortality, Why Africa Falls So Far Behind" tells the story of a patient who had given birth and remained at home for five days, while near death from a complicated delivery including bleeding, infection and dehydration before finally entering a hospital. From the perspective of a health care professional, Ismail is able to discuss the situation from an educated view, and lists six main factors that are contributing to this disheartening problem. The picture to the right is of Ismail at work on a project called "Safe Motherhood" that focuses on providing prenatal and delivery care to women. The Partners in Population and Development's (PPD) blog has a recent entry, "MP's Want More Investment in Maternal Health" by Evelyn Lirri that describes the event in which members of parliament from 13 African countries met to "deliberate on health issues affecting the continent." Lirri, part of PPD, focuses on the group's discussion of issues relating to pregnancy, and included statistics and quotes from the conversation to illustrate the grim realities that expectant mothers face. I left my comments and questions on each of these blogs as well as posted them below.

RH Reality Check: On Maternal Mortality, Why Africa Falls So Far Behind

Hi Edna,

Thank you for providing information and stories from the perspective of an educated woman in Africa's medical field. We often hear reports of such circumstances through journalists or media, but not directly from the people involved such as yourself; and in this manner your account provides sincerity and authenticity unmatched by reporters. Your explanation of maternal morality and its causes presents deep insight and builds an emotional connection for your readers while also offering objective facts. I appreciate your work and these aspects of your blog. I do, however, have a few questions. You mentioned that the patient was able to be treated "free of charge," but as many women do not come to hospitals or clinics because of the cost, why this case was free? Is that option available at Edna Adan Maternity Hospital for others who cannot afford maternal health care, or was it done only for her situation? From what I have read in other reports, it seems very difficult for expectant mothers to pay for prenatal or delivery care throughout Africa. Do you know of any hospitals, clinics, nonprofits or governments attempting to fix this problem? If such offers are available, pregnant ladies and their families must be made aware of the option. Also, you stated that, "poverty is a strong factor that prevents women from seeking help" but even if they were to seek assistance, medical centers do not have adequate staffing or equipment. Furthermore, many articles I've come across such as the Washington Post's report "In Sierra Leone, Every Pregnancy is a 'Chance of Dying'" find that even where there are doctors or nurses, they are not properly trained or at least not trained in all fields for which their help is requested. (For example, the Post story mentions a trained ophthalmologist serving as a de-facto obstetrician.) Do you think this lack of education among medical staff (including midwives) is of serious consequence to the health of women who are with child? I fear it is a huge obstacle to overcome, and that educated doctors, nurses and midwives may be the key to preventing pregnancy complications. All in all, your reasons for why "Africa falls so far behind" are sound and logical, and lend good information to the cause, and I look forward to hearing from you at www.devonvdemars.blogspot.com.


Partners in Population and Development: MPs Want More Investment in Maternal Health

Hi Evelyn,


It is great to hear that so many African governments are actively addressing the issue of maternal health. Your post was very informative and professional, and I appreciated the addition of quotations and numbers (such as the facts on how many women die during childbirth, as portrayed in the picture to the left,) to enhance the report. I believe that if governments start recognizing the lack of care for pregnant women, positive changes will start to occur and create a safer maternal experience. Another blog I've commented on, called RH Reality Check with a post titled "On Maternal Mortality, Why Africa Falls So Far Behind" states that "In 1948, the constitution of the World Health Organization was passed, with its first article stating, 'Health is a fundamental Human Right.'" It is my opinion, and I presume yours, that governments must begin protecting this right and getting females the correct maternity care that they need. Some governments are taking steps toward progress, an example being the availability of the Misoprostol tablet you mentioned in your entry. In regards to the drug, how obtainable is it for women who need it? Will it be commonly found in health centers or only in a few? As many people who are pregnant do not realize their health options, I worry they might not be aware of this new development. Your post also stated that, "cases that necessitate a cesarean can significantly be reduced through access to prenatal care, skilled attendance at birth and emergency obstetric care," but is there any governmental plan to provide those things, or only talk of it? Additionally, I'd be interested to know what this "roadmap to accelerate the reduction of maternal mortality" includes. I'm glad to know governments are putting more priority on this issue, and I hope it will continue to be a topic of importance in the political conversation. Thank you for your entry. I've included a link to my blog at www.devonvdemars.blogspot.com.
 
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