![[Senegal] Khady Sow. [Date picture taken: 08/10/2006]](https://assets.thenewhumanitarian.org/s3fs-public/styles/responsive_large_2x/public/images/20068186.jpg.webp?itok=xvxFnqIx "Underage marriage is prevalent in West Africa")
Small and delicate, Khady Sow wears her hair down and braided. Around her neck dangles a small vial of perfume on a multi-coloured string of beads. Self-image is important to most teenagers, but it goes much deeper for Khady.
Married two years ago at about age 15 to a young shepherd, Khady lost her first child, a girl, after a long and arduous labour. The birth also left her with an obstetric fistula, making her incapable of controlling her bladder and rectum.
The shame of the problem drives many girls and young women into isolation. Some communities shun them.
“When I lost my baby, I was very sad,” said Khady, who now lives with her parents. “And when I got the fistula, it was too much, I was so ashamed. I didn’t know what had happened, I didn’t even know it was from the delivery.”
Fistula usually occurs during prolonged labour, when the baby’s head pushes too long on the mother’s pelvis, cutting off the blood supply. As a consequence, the tissues die and a hole forms between the mother’s bladder and vagina, between her rectum and vagina, or both, as in the case of Khady.
Nearly two million women in developing countries suffer from fistula and there are between 50,000 and 100,000 new cases each year worldwide, according to the World Health Organisation (WHO).
WHO estimates that in areas where there is a high incidence of maternal mortality, two to three women develop a fistula for every 1,000 live births.
The rate of fistula is higher in areas with a high incidence of maternal mortality – West Africa has the highest maternal mortality rate in the world. The Tambacounda region of southeast Senegal, where Khady is from, has the highest rate in the country, with 1,200 deaths for every 100,000 live births, which is double the national average
Poverty and traditions
The outcome of Khady’s pregnancy could have been far different if she had been taken to a healthcare centre sooner. A simple caesarian would have saved her baby and prevented the fistula, doctors say.
But in the region of Tambacounda, as in most remote African villages, childbirth is done at home and if complications arise women are rarely taken for medical treatment. But the rough and dense terrain of Tambacounda make this difficult. The roads, even when paved, are tough to navigate. Flooding during the rainy season complicates transportation further.
“Many villages get cut off from the rest of the country, without a phone and no open roads. We won’t even know what is going on” in the more remote areas, said Dr. Bassirou Ndir, chief medical doctor for the region.
He said that it is not uncommon for women to be transported by bicycle or in a hammock to the main road, where, if lucky, a car might pass by and take her to the hospital.
But even if the woman does reach a clinic there might not be anyone to help her.
“All the personnel are in Dakar, where there are fewer problems. Here we have many problems and there is no one,” said Doussou Samoura, a midwife since 1992 at the Tambacounda health referral centre.
Tradition also plays a role. Tambacounda has seen the intermingling of many groups from neighbouring Mali, Guinea, The Gambia and Mauritania and with it the sharing of ethnic and cultural traditions. Female genital excision, the cutting and sometimes sewing of vaginal tissues, that is practiced by some ethnic groups can produce complications during childbirth. Members of the Mandigo ethnic group believe that giving birth is a struggle between life and death and that a woman must face it alone.
“It’s a rite of passage for a women and she must show courage. If she asks for help, she will be looked down upon,” said Babacar Mane, expert on maternal health for the United Nations Population Fund (UNFPA) in Tambacounda.
Despite the health risks to women, many of these practices remain. “We need to end these customs, keep the good ones, but end the bad ones,” said Raby Cisse, president of the Federation of Groups to Promote Women. “We don’t want women dying during childbirth or developing a fistula. These misfortunes are impeding our development.”
Efforts to educate and sensitise communities have been undertaken by local women such as Oumou Diallo, regional president of Women Elected Locally in Tambacounda. She recently completed a tour of 35 villages to warn of the dangers of underage marriage, which is widely practiced in the region.
This custom aims to prevent sex and pregnancy out of wedlock and uphold family honour. These early marriages, however, lead to young girls becoming pregnant before their bodies can handle the pregnancy and serious complications often arise during childbirth.
Simple solution made complex
Strengthening health services, improving roads, educating girls, promoting respect for women’s rights and reducing poverty are all ways to help prevent women from developing fistula, experts say. There are also ways to help women who already suffer from the problem.
Nearly 80 to 90 percent of cases can be successfully treated with surgery, allowing these women to return to a normal life within their communities, doctors say. Dr. Sogo Milogo, a surgeon at the regional hospital in Tambacounda, said, however, that he only operates on about 15 women per year suffering from fistula. This is a small number in view of the extent of the problem in the region.
Most women wait too long to seek help because they can’t access it, either due to financial constraints or lack of knowledge, preferring to consult the local practitioner of traditional medicine, health workers say.
Recently, a 16-year-old girl who visited Dr. Milogo underwent a 12-hour operation. “When she arrived she was very thin and infected,” he said. “The tissues in her vagina were all deadened and I had to reconstruct the area using skin from her posterior and remove her uterus.”
Usually, surgery on a fistula lasts only 20 minutes, and in Senegal costs between $150 and $200 US dollars.
Khady was also treated by Dr. Milogo. She was lucky to receive financial help from the health committee of Koumpentoum, which paid for her antibiotics, and from UNFPA, which took on the cost of her surgery.
She has already had three operations and after a planned fourth, she hopes to finally be cured and resume a normal life.
ad/kdd/cs
Married two years ago at about age 15 to a young shepherd, Khady lost her first child, a girl, after a long and arduous labour. The birth also left her with an obstetric fistula, making her incapable of controlling her bladder and rectum.
The shame of the problem drives many girls and young women into isolation. Some communities shun them.
“When I lost my baby, I was very sad,” said Khady, who now lives with her parents. “And when I got the fistula, it was too much, I was so ashamed. I didn’t know what had happened, I didn’t even know it was from the delivery.”
Fistula usually occurs during prolonged labour, when the baby’s head pushes too long on the mother’s pelvis, cutting off the blood supply. As a consequence, the tissues die and a hole forms between the mother’s bladder and vagina, between her rectum and vagina, or both, as in the case of Khady.
Nearly two million women in developing countries suffer from fistula and there are between 50,000 and 100,000 new cases each year worldwide, according to the World Health Organisation (WHO).
WHO estimates that in areas where there is a high incidence of maternal mortality, two to three women develop a fistula for every 1,000 live births.
The rate of fistula is higher in areas with a high incidence of maternal mortality – West Africa has the highest maternal mortality rate in the world. The Tambacounda region of southeast Senegal, where Khady is from, has the highest rate in the country, with 1,200 deaths for every 100,000 live births, which is double the national average
Poverty and traditions
The outcome of Khady’s pregnancy could have been far different if she had been taken to a healthcare centre sooner. A simple caesarian would have saved her baby and prevented the fistula, doctors say.
But in the region of Tambacounda, as in most remote African villages, childbirth is done at home and if complications arise women are rarely taken for medical treatment. But the rough and dense terrain of Tambacounda make this difficult. The roads, even when paved, are tough to navigate. Flooding during the rainy season complicates transportation further.
“Many villages get cut off from the rest of the country, without a phone and no open roads. We won’t even know what is going on” in the more remote areas, said Dr. Bassirou Ndir, chief medical doctor for the region.
He said that it is not uncommon for women to be transported by bicycle or in a hammock to the main road, where, if lucky, a car might pass by and take her to the hospital.
But even if the woman does reach a clinic there might not be anyone to help her.
“All the personnel are in Dakar, where there are fewer problems. Here we have many problems and there is no one,” said Doussou Samoura, a midwife since 1992 at the Tambacounda health referral centre.
Tradition also plays a role. Tambacounda has seen the intermingling of many groups from neighbouring Mali, Guinea, The Gambia and Mauritania and with it the sharing of ethnic and cultural traditions. Female genital excision, the cutting and sometimes sewing of vaginal tissues, that is practiced by some ethnic groups can produce complications during childbirth. Members of the Mandigo ethnic group believe that giving birth is a struggle between life and death and that a woman must face it alone.
“It’s a rite of passage for a women and she must show courage. If she asks for help, she will be looked down upon,” said Babacar Mane, expert on maternal health for the United Nations Population Fund (UNFPA) in Tambacounda.
Despite the health risks to women, many of these practices remain. “We need to end these customs, keep the good ones, but end the bad ones,” said Raby Cisse, president of the Federation of Groups to Promote Women. “We don’t want women dying during childbirth or developing a fistula. These misfortunes are impeding our development.”
Efforts to educate and sensitise communities have been undertaken by local women such as Oumou Diallo, regional president of Women Elected Locally in Tambacounda. She recently completed a tour of 35 villages to warn of the dangers of underage marriage, which is widely practiced in the region.
This custom aims to prevent sex and pregnancy out of wedlock and uphold family honour. These early marriages, however, lead to young girls becoming pregnant before their bodies can handle the pregnancy and serious complications often arise during childbirth.
Simple solution made complex
Strengthening health services, improving roads, educating girls, promoting respect for women’s rights and reducing poverty are all ways to help prevent women from developing fistula, experts say. There are also ways to help women who already suffer from the problem.
Nearly 80 to 90 percent of cases can be successfully treated with surgery, allowing these women to return to a normal life within their communities, doctors say. Dr. Sogo Milogo, a surgeon at the regional hospital in Tambacounda, said, however, that he only operates on about 15 women per year suffering from fistula. This is a small number in view of the extent of the problem in the region.
Most women wait too long to seek help because they can’t access it, either due to financial constraints or lack of knowledge, preferring to consult the local practitioner of traditional medicine, health workers say.
Recently, a 16-year-old girl who visited Dr. Milogo underwent a 12-hour operation. “When she arrived she was very thin and infected,” he said. “The tissues in her vagina were all deadened and I had to reconstruct the area using skin from her posterior and remove her uterus.”
Usually, surgery on a fistula lasts only 20 minutes, and in Senegal costs between $150 and $200 US dollars.
Khady was also treated by Dr. Milogo. She was lucky to receive financial help from the health committee of Koumpentoum, which paid for her antibiotics, and from UNFPA, which took on the cost of her surgery.
She has already had three operations and after a planned fourth, she hopes to finally be cured and resume a normal life.
ad/kdd/cs
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
Share this article
