We started our day at Dhaka Medical College's teaching hospital where we learned more about one of the most common pregnancy-related morbidities (or disabilities) that poor women endure in childbirth; obstetric fistula. An obstetric fistula is when a woman suffers an obstructed labor, ultimately tearing a hole in her birth canal. Fistulas lead to incontinence of urine, feces and often cause infertility. Equally as devastating is that most women with fistulas are ostracized by their families and communities.
The good news is that there is a surgical procedure to treat fistula and 90 percent of fistula cases can be repaired. Yet still, many women who suffer are not aware that this surgery may be available to them and as a result they can endure lifelong emotional trauma. Obstetric fistula is a condition that is simply hard to ignore once you understand its implications.
In the summer of 2009 when filming, No Woman, No Cry in Tanzania, we met Agnes in the Ol Danyo Sambo clinic and learned through talking to her that she'd been suffering from fistula for 11 years. While Agnes's story did not make it into the film, we knew her story was too important to not share. We recently created an education module about fistula that features her story in an effort to educate American moms about the issue. The short film begins though with footage shot in this very hospital in Dhaka. (Visit everymothercounts.org to watch the film.)
Awareness is increasing because of the advocacy efforts of many organizations and fistula campaigns around the world. Those efforts have been strongly led by UNFPA along with their former Executive Director, Thoraya Obaid. Thoraya has been a true leader in advocating to increase the profile of this preventable pregnancy-related tragedy. It is important to keep in mind that globally, for every single maternal death, there are at least 20 morbidities.
Our friends at UNFPA showed us around the National Fistula Center at the Dhaka Medical College and their nearby Fistula Rehabilitation Center. Dr. Ferdousi Islam, the head of the OB/GYN department told us that an estimated 71,000 women suffer with an obstetric fistula in the country and every year there are another 3,000 to 4,000 cases. The National Fistula Center, established in 2003, provides surgeries to women who need it (free of charge) and can then refer them to the rehabilitation center to get re-acclimated to living in their communities once rehabilitated.
We met with patients in the pre-operative room who were waiting their turn -- one of whom was 45 years old and had been suffering from a fistula for 12 years. In the next bed was a girl who looked to be no older than 15 or 16 years old. Both women had lost their babies during their deliveries. Adolescent girls are especially at risk and are five times as likely to die or be injured in childbirth. The issue is a real problem in Bangladesh due to high rates of child marriage. When a girl's body is not yet fully matured, she is more likely to experience prolonged labor, which, in the worst-case scenario, can lead to death for both mother and baby. Like so many development issues, this is one that requires a holistic approach. Prevention is as important as treatment to prevent fistulas and maternal mortality. But rehabilitation is also paramount for full recovery for those who have received treatment so that these women can reenter society.
It is important to focus on adolescent girls when we are addressing prevention of maternal mortalities and morbidities. That's why we were so incredibly energized by our next stop where we traveled outside the city center with BRAC to visit their SoFEA program (Social and Financial Empowerment of Adolescents). While still a pilot program for BRAC, it is already making a tremendous impact for the 12,500 girls they have reached so far. The 15-20 girls we met with all between the ages of 11-18 years old were bright, energetic, and confident and what was most encouraging, they were hopeful about their futures. Today in Bangladesh, it is estimated that 65 percent of girls under the age of 18 are married. But SoFEA is setting out to provide girls with options and education so that they're better positioned to delay marriage. With support from the Nike Foundation, these girls gathered together to support each other, to learn life skills and some vocational skills that could position them to get jobs. The club even had a laptop they use to learn basic computer skills (which they also used to take our picture and play music for dancing.)
If girls are given tools to provide for themselves they can continue their studies longer, which will help to delay early marriage and first births which will keep them healthier. These girls are the key and we were reminded that future mothers count too. It was an incredible visit and we were sorry to peel away but we had a premiere to get back to in Dhaka.
The Bangladesh premiere of, "No Woman, No Cry" was really the anchor for this trip and the final country profiled that I have returned to in order to screen the film. DFID, the UK's aid agency, helped to translate the film into the local language of Bangla so that we'd be able to take it to the communities here. ICDDR,B, CARE, DFID and BRAC all joined forces to put on a fantastic event. After the screening, I was joined on a panel moderated by Tim Evans, Dean at the James P. Grant school of Public Health at BRAC University and ICDDR,B, Birthe Locatelli-Rossi, Chief, Health and Nutrition Section UNICEF) and Dr. Faruque Ahmed, Director of the BRAC Health Program. The portion of the film that focused on Bangladesh centered on BRAC's Manoshi program, which we had revisited on day one. It was great to be part of a discussion where we could celebrate the progress made as recently as our first trip to film, while still having a real conversation on what else needs to happen to achieve the 2015 MDG targets.
The event brought together members of the MNCH community in an informal setting to take a hard look at some of the gaps highlighted in the film but in a setting/institution that is all about analyzing data for the community at large in an attempt to find life saving solutions.