Family planning is crucial for those in the developing world

Haik Kocharian

A darling, petite young woman with a beautiful smile on the outside, Mecca’s reality is a daily onslaught of pain and shame due to a completely preventable injury of pregnancy, afflicting a million women and resulting in untold stillbirths.

I was in Ethiopia with a project focused on the appalling absence of Water/Sanitation/Hygiene (WASH) in health-care facilities. It’s a global health scandal impacting hundreds of thousands of clinics and hospitals around the world. But I hadn’t anticipated meeting Mecca.

{mosads}Mecca has been pregnant 10 times. She has seven surviving children. She is only 30 years old.


We hiked through farmlands to reach the small stick and mud house where Mecca lives with her husband and seven children. She greeted us with her welcoming smile that belies her daily suffering. After the birth of her fifth child, a hard labor that lasted two days, she began leaking urine and for three years now, she’s suffered from a preventable injury called “fistula.” Fistula typically occurs during obstructed labor, leaving an open hole through which urine and feces leak uncontrollably.

The lifetime risk of a woman in sub-Saharan Africa dying from pregnancy or childbirth is 1 in 22 according to the World Health Organization, WHO. For every woman who dies, at least 20 more suffer severe gynecological problems following childbirth. That’s the terrible reality for women around the world and Mecca is one of them. Mecca has a constant, painful rash from leaking urine. In more extreme cases, women are left crippled by nerve damage. 

Maybe as bad as the symptoms is the shame. Mecca told me that people pinch their noses if she enters a home. She tries to hide her condition when she goes to market, but she told me she’s ignored and avoided because she smells.

For the last year, she’s been unable to work in the fields as a day laborer (also her husband’s livelihood), because her condition is worsening. She’s in pain, lonely, depressed and cries a lot. She says sometimes it’s hard to get out of bed early to collect water and firewood and care for her children. To his credit, her husband has not left her. For many women, fistula drives their husband away. 

Mecca became pregnant five more times after her fistula injury. The last three babies died. That’s another tragedy attributable to fistula. From what I understood through an interpreter, pregnancies eight, nine and 10 resulted in two stillbirths and a miscarriage.

I met dozens of women like Mecca and nearly every single one of them had lost at least one child during childbirth. The catastrophic loss of a child was such a common story that I found myself feeling disturbingly surprised when a woman had not lost a child or had lost “only” one child.

I met these women because they had come in from the countryside to attend a screening to find out if they were candidates for reparative fistula surgery. According to the Fistula Foundation, one million women suffer from fistula but for every woman who receives reparative surgery, at least 50 — likely more, it’s hard to know because they stay hidden — go without. Surgery is clearly not the solution. Prevention is the key.

Which is why it’s vital that healthcare facilities have water and sanitation so women will be encouraged to give birth in facilities rather than at home. And women must also be able to regulate when they have babies and how far apart. Some call it Healthy Timing and Spacing of Pregnancies, HTSP. Others call it family planning. For young women who are able to wait to have babies until their bodies are fully developed, and then have them well-spaced, it’s called life-saving  — for them and their children.

A child in a developing country has a higher chance of dying if he or she has siblings close in age, according to WHO. HTSP also prevents unintended pregnancies, which reduces abortion. Conversely, low birth weight and stunting (lifelong cognitive development problems) decrease as the spacing between births increases. 

Yet despite so many health and economic benefits, somehow the idea of planning ones family has become a dirty word. To deny children a healthy start undercuts so much of the life-affirming good work Americans do around the world. Sensitive, modern family planning is entirely consistent with conservative values and family values. Even in the conservative Ethiopian culture where Christianity plays a central role, the wives and husbands I spoke with were quite open to family planning. What got in the way was the lack of information, cost and availability.

Access to education and family planning methods acceptable to different cultures and economies — from sophisticated natural planning to safe and cost-effective long-term options — would save so many lives, prevent suffering, and position families for greater security and success.

I didn’t expect to meet Mecca. Now that I have, I can’t help but think of the years of shame, pain and grief this young woman could have avoided had she had access to family planning. The last I heard, Mecca was a candidate for reparative fistula surgery. I do not know her outcome. But if we really cared about her pregnancies and the survival and health of millions of women and children, we’d aggressively prevent their suffering and premature deaths with readily available compassionate care that includes education and access to healthy timing and spacing of births.

Susan Barnett is the founder of the nonprofit Faiths for Safe Water, an advocacy project that focuses the faith voice on global water issues.

Tags Ethiopia Fistula Healthcare Susan Barnett

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