A new documentary narrated by Meryl Streep aims to raise awareness about a debilitating childbirth injury that affects an estimated 2 million women -- and many people don’t know even exists.
"Shout Gladi Gladi" focuses on the work of a Scottish philanthropist, Ann Gloag, and her organization’s effort to fight obstetric fistula, a medical condition that results in women leaking urine or feces.
"When this happens to women, they become outcasts in society," said Gloag, who runs the Freedom From Fistula Foundation. "Even their own sisters and mothers turn away from them because of the smell."
Most cases of fistula are caused by a prolonged obstructed labor. The scenario often looks like this: A woman is in labor for two or three days, without access to a hospital. The pressure of her baby's head damages the delicate tissue in the birth canal. After the baby is born, the tissue dies, leaving a hole between the birth canal and the bladder or rectum, and the woman incontinent.
For women with fistula, life can be painful and difficult. They often are shunned by their communities, can't work, and may become malnourished as a result of reducing their food and water intake to minimize leakage.
But the injury is entirely fixable with surgery. That's where Gloag’s foundation steps in. Her organization has set up projects in Kenya, Sierra Leone and Malawi, where they offer women free surgery to repair fistula. The goal is to operate on as many women as possible, so they can begin to move on with their lives, free from the pain and stigma.
While fistula has been almost eradicated in the developed world, the World Health Organization estimates that 50,000 to 100,000 women develop obstetric fistula each year. Most of those cases occur in sub-Saharan Africa or south Asia. "Nobody in Britain gets it," said Gloag. "We get obstructed labor just as they do, but you would immediately do a cesarean" section.
Access to surgical care across Africa is abysmally low, and many women who need C-sections can’t get them. According to the Guttmacher Institute, 25 of the 29 countries in sub-Saharan Africa have caesarian rates of 5 percent of births or lower. WHO says the ideal rate for a country’s caesarean sections is 10 percent to 15 percent.
Gloag, a former nurse, said fistula is more common in areas where women live long distances from hospitals, and among young women whose pelvises are not fully formed before getting pregnant.
"We get a lot of girls who are 12,13 years old -- they are not really ready for it," Gloag said. "If you could stop early marriage, stop early pregnancy and improve maternal health care, you could end fistula."
Adam Friedman, co-director of "Shout Gladi Gladi," said he hadn't heard of the condition before he met Gloag, and was shocked to learn how common it is in the developing world."There was an obvious story here," he said. "When you hear about it, you go, 'Oh my God, this must be dealt with.'"