A Tragedy That Doesn't Have to Happen

Nairobi -- Nineteen-year-old Christine Nyaboke became pregnant in 2005. She was in labor for three days at home with a traditional birth attendant because her mother had no money to take her to hospital. She had a stillbirth, and later discovered that her body was painfully damaged.

Nyaboke, not her real name, had a fistula, a severe childbirth injury that leaves its victims constantly leaking urine and feces. As a result, she was shunned and abused by former friends and others in her community. She could not leave home for social events, to look for work or even to go to church. She became depressed and contemplated suicide.

She was just one of the more than 50 women and girls I interviewed late last year who suffered obstetric fistula. Unless it is surgically repaired, it ruins their lives. With the G-8 planning to discuss maternal health at its summit meeting this week in Canada, I can't help but think of how these girls' and women's lives would not have been torn apart if they had access to appropriate health care, including family planning services, at the time of their pregnancy and childbirth.

Their stories were similar. They were about poor knowledge of sexuality and lack of family planning information and services or the money or transportation they needed to get help. They were about poorly staffed and equipped health facilities with no capacity to handle obstetric complications or ambulances to move women to facilities where they could be helped. They were about the high cost of fistula repair. And this is where accountability comes in: none knew how, or to whom, they could complain about or challenge any of these barriers. None had been offered any remedy for failings that had occurred in their cases.

These stories are not exclusive to Kenya. Most resource-poor countries, but especially those in Africa, are struggling with these problems. Even acknowledging the major challenges, though, it is clear that many countries could do more to improve maternal health care. Greater effort is urgently needed to avoid the hundreds of thousands of preventable maternal deaths around the world each year, to prevent the millions of childbirth injuries, and to restore lives of dignity to the estimated two million current fistula sufferers.

In many African countries -- Kenya and South Africa, for example -- there is a de facto two-tier health system. The private system provides good quality health services for the rich, and an under-resourced weak public health system provides lower- quality services to the poor and marginalized. There is an urgent need to strengthen these public health systems, or otherwise ensure that everyone has better access to quality care.

Canada, the G-8 summit host, is making maternal and child health a priority for this year's meeting. If the G-8 countries embrace as a priority providing access to comprehensive reproductive health services (including legal, safe abortions) and strengthening health system accountability, they could save the lives of millions of women and children.

Canada has indicated that accountability will be a key theme of the G-8 deliberations. Health system accountability - giving people a complaint mechanism and redress -- is weak in many countries, and strengthening it can greatly enhance health systems. It can allow the people served to let the government know what is working and what needs fixing. This requires accessible and effective ways of providing feedback, lodging complaints, and ensuring that the feedback leads to improvements.

Governments often rely on aid funds to make these improvements, and donor governments should hold them accountable for using that money wisely. There should be oversight to avoid fraud and corruption and monitoring of maternal health programs, for example, to ensure they are reaching those who need them most.

The women and girls I interviewed were among the lucky few attending free fistula repair camps sponsored by the UN and a nonprofit health organization. They had some wise things to say about what the government should do to improve maternal health and prevent and treat fistula.

Their demands were modest but sensible: make it possible for us to deliver our babies in safety, with facilities and providers who respect our rights and have what it takes to do their jobs well. Listen to us when there are problems. And fix the problems so that no other woman or girl has to endure the devastation of fistula. Their message is one of health system accountability, or rights, and of dignity.

The G-8 has an opportunity this week to save lives like Nyaboke's. It should listen to what these girls and women have to say.