Mothers of Ethiopia Part III: Battling Pregnancy Complications

Editor's note: Hanna Ingber Win, the Huffington Post's World Editor, was recently invited by the UN Population Fund to visit its maternal health programs in Ethiopia, which has one of the world's worst health care systems. In the U.S., a woman has a 1 in 4,800 chance of dying from complications due to pregnancy or childbirth in her lifetime. In Ethiopia, a woman has a 1 in 27 chance of dying.

This is the third of a five-part series on what she learned on her trip.

MEKELLE, Ethiopia -- Dima Yehea's two-year-old son has large brown eyes and a sweet, carefree smile. He sits on his mother's lap wearing only an old T-shirt. Dima, dressed in a loose hospital gown, looks at me with intent, studious eyes. Her baby turns towards her, grabs her left breast with both hands and nurses for a few minutes. As the baby focuses on his meal, Dima concentrates on me, a Westerner in Ethiopia.

Dima also wears a big smile on her face. Her hair has recently been styled, pulled back in tight braids, in preparation for her departure from the hospital and trip home to her rural village.

A young woman living in a country with one of the world's worst health care systems, Dima has experienced needless, preventable pain and tragedy. Yet she appears happy to share her story. To an American, it is a story of the poor state of women's health care in Ethiopia. To Dima, it is a story of triumph and hope.

• • • • • • Dima Yehea sits at the Mekelle branch of the Hamlin Fistula Hospital in Mekelle, Ethiopia, on September 4, 2009. Dima married at age 15, and her husband forced her to have sex with him. She was too young to understand what he was doing, she says. When she gave birth, she did not have access to a skilled birthing attendant. She had obstructed labor and developed an obstetric fistula, a hole between her bladder and vagina, causing her to leak urine.

Dima was 15 when her family prepared a wedding ceremony and married her off to a man she had never before met. Soon after getting married, her husband forced himself on her.

"Did you understand what he was doing?" I ask her.

Dima's smile slips away. She slowly shakes her head. "I was a kid," she says through a translator. "I didn't know what was happening."

The sex was painful, but her husband did not stop.

Dima soon became pregnant with her first child. She was living in a rural village called Late about 145 kilometers from Mekelle, the largest city in northern Ethiopia.

Like 94 percent of Ethiopian women, Dima went into labor at home without access to a skilled birthing attendant. Too young and undeveloped to be giving birth, Dima's body could not handle the labor. The baby's head pushed down on her pelvic bone, not yet wide enough to let the baby pass naturally, for 48 hours.

Dima eventually gave birth, but the baby had died during the protracted labor. Plus, the prolonged pressure caused the tissue between her bladder and vagina to die. A hole called an obstetric fistula formed.

Obstetric fistulas are practically unheard of in developed countries because women give birth at a later age and therefore have more developed bodies - plus, even more importantly, they have access to medical care. If a woman has a complication during pregnancy, like about 15 percent of women do, she can have a Cesarean section.

Dima had no such luck.

In Ethiopia, where such surgery is rarely an option in the rural areas where women like Dima live, obstetric fistulas plague about 100,000 women, says Karen Beattie, the project director for Fistula Care, a project managed by EngenderHealth and funded by USAID. The exact number of women living with fistulas -- like the exact maternal mortality rate -- remains unknown due to lack of good population-based statistics, she says.

About 2 million women in the developing world currently live with untreated fistulas, according to the UN Population Fund.

"The whole problem lies in detection of difficult labor and appropriate referral to emergency obstetric care," says Dr. Melaku Abriha, an obstetrician and gynecologist who runs the Mekelle branch of the Hamlin Fistula Hospital.

The hospital's facility in Addis Ababa opened in 1974 and has treated more than 32,000 women, according to public relations officer Feven Haddis. The Mekelle branch opened in February 2006 and has operated on around 600 women from rural villages surrounding Mekelle. Ninety-one percent of the surgeries have been successful, Dr. Melaku says.

Dima's fistula caused her to leak urine at all times. The uncontrollable discharge left her uncomfortable and smelly.

Still just a teenager, Dima became so embarrassed of herself that she stopped seeing her friends.

"I felt like they were talking about me behind my back," she tells me.

Dima told her husband that she did not want to have sex with him. She felt unhealthy and uncomfortable. But he insisted. After having a second child, the little boy now sitting on her lap, Dima began refusing to have sex. Her husband divorced her and married another woman. Dima moved back home with her parents.

Her baby stops nursing and turns to watch me. Dima's bare breast rests on top of her gown. She explains that she stayed at her parents' house, without any contact with the outside world, until a local non-governmental organization visited her village and found her. The group, Relief Society of Tigray, helps women who have developed fistulas. They brought Dima to the hospital in July, and Dr. Melaku performed surgery on her to repair the hole between her uterus and bladder. The surgery cost about US$400 and was paid for by the hospital.

The surgery was successful, and Dima will return to her village the day after I meet with her.

I ask Dima how she feels now, and the joy returns to her face. Her eyes open wide, and she starts talking fast and loud. "I am happy!" she says, pounding her chest with her clenched fist. "I will start to talk with the neighbors and community. I will look for a new job, and I will start a new life."

She says that she cannot return to farming because after living with a fistula for six years and undergoing surgery, she does not think her body will be strong enough for the intensive work. In general, women who undergo fistula surgery can return to farming once they have fully healed, says Karen Beattie of Fistula Care.

Dima also no longer has a husband to help her with the farming. Instead, she says, letting out a laugh, she will become a businesswoman.

"My plan is now to change my life," she says. "I will do business and earn some money for me and my baby."

It is unlikely that the number of fistula cases in Ethiopia is decreasing. However, more places like the Hamlin Fistula Hospital are opening and serving more women, says Beattie. Furthermore, increased attention by the international aid community over the past 10 years on the issue of fistulas has led to greater awareness about the problem of both this medical condition and women's maternal health in general.

Despite the gains, only about a third of the 9,000 fistula cases that occur in Ethiopia each year get treated, according to the UN Population Fund.

"Fistula is a marker for what is happening for maternal health more generally," Beattie says. "It has shined a light on the need for more access to emergency obstetric care."

Tomorrow: Visiting a rural health post in Ethiopia

Read the first installment on one woman's journey to find a doctor in rural Ethiopia here, and the second about girls fleeing child marriage here.

Comments

[LyssaBarnes]

Heartbreaking.

We must remember the plight of others when we examine our own. If you pray, meditate or cast a circle for your own prosperity, don't forget your fellowman.

[Keith23]

amazing photographs of a beautiful people. along with your excellent writing, great photojournalism.

[pinkibus]

The biggest problem in Ethiopia is overpopulation. And it is the biggest problem in the world. Birth control, abortion, education and financial empowerment are far more important than health aid or food aid.

[sanileo]

Too young and undeveloped to be giving birth, Dima's body could not handle the labor. The baby's head pushed down on her pelvic bone, not yet wide enough to let the baby pass naturally, for 48 hours"

I guess this type of phenomenon is not limited to Ethiopia alone. This country is having an increasingly major problem of 15year olds having babies. SO that comes out as ok because america has a good health system. The problem of early marriages in africa is more complicated than it is make believe. to understand it, we need to look at the socio-economic benefit that the parents that give their childrens hands in marriage get.

[Cherie King]

lets not gloss over the fact that many of these countries practice FGM and that can contribute to these fistulas.

[34MillionFriends]

Hi Hanna, do you know about our lovely 34 Million Friends of the UN Population Fund? www.34mill­ionfriends­.org I'm so glad you've seen the the dificult work it does for the world's most vulnerable women. Cheers, Jane ROberts

[jackjack]

This condition is not just from difficult labor. Its a common thing in that the Congo conflict. Gangs of men from rivaling tribes attack each others' women, gang rape her and then render her unable to produce more children by shoving something up in her like a steel pole, a tree branch, a bayonet...or even pushing a shotgun up in her and blasting into her uterus.

Its absolutely horrific.

[escribacat]

Sick.

[hollybork]

In the face of what the medical profession knows about the risk of fistulas from child pregnancies, the Ethiopian and Somalian cultures continues to permit young women to be married off before age 18 for no more compelling reason that to fulfill some man's lust. What is the matter with the world that women are so little valued and so little protected? What can we do about the discount placed on women's lives?

[escribacat]

Arm the women.

[ROSAGrids]

The best solution would be to prevent such unfortunate situations. Be proactive about the problem. Eventhough it is hard to change a culture which was there for centuries, there should be a huge effort to educate the society not to marry off their children at least before they reach adulthood.

[ROSAGrids]

Reading this blog brings back so many memories of my country---Ethiopia. My country has been hit by many problems, and Fistula is one of the biggest issues. 85% of the population lives in rural areas where there is virtually no hospital compared to the number of people who need care.

I am really grateful to what non government organizations such as Relief Society of Tigray are doing in the country. But we need more of such organizations.

[Ping]

And yet they have a large and active military.

[ROSAGrids]

Ofcourse we do. But have you wondered 'why'? Because there is a threat from inside and outside. If you look at the past 10 years, we had major wars with Eritrea and Somalia. In addition to this, the government is not settled yet. There are opposition parties who would not blink if they had an opportunity to wage a war against the current administration. If the need arises to defend the country, as it happened many times recently, having a strong military is the least we can ask for.

[fattine]

What do you expect? From all the threats, they are smart to have and large active military. And what does that have to do with fistula and childbirth anyway?

[KingMidas]

Of course, what really interests the bloggers is the thought that her husband 'raped' her.

Well, if he did, what of it? It happens in the USA every day without any cultural mores to justify it. No one is forcing 15 year olds to marry in America, however, American women are claiming their husbands also rape them

As for those who worry about other countries and the woes of women there : Charity begins at home.

Many and many a physician can tell you the self same horror stories occurring in America daily because of lack of health care. Unfortunately, now that America is becoming more 'integrated' reporters can no longer look for salacious ways to boost readership or ego by just trotting down to the nearest black ghetto to find 'sufferers' report on. So they have to go to ETHIOPIA.

But it is right here in your backyard. Save your pity and put your energies in the Public Option. Then and only then will you have the moral right to be announcing the failings of other nations to all and sundry in the hopes of feeling better about yourselves.

[jessicadevyn]

Please. We live in a global economy and global world now. All humans are our brothers and sisters. Supporting the Public Option and Supporting Women in Ethiopia isn't an "either or" situation. You can have empathy for ALL people around the world.

Did you see the headline? A woman here has a one in 4,800 chance of dieing in childbirth. In Ethiopia it's one in 27.

[redhead61]

I think you need to realize that we are ALL a part of one race....the human one...

find some compassion ...

[escribacat]

What exactly is your point?

[Amera]

I saw the documentary A Walk to Beautiful 18 months ago about these women and their plight. Very moving.

[Callyson]

I also saw A Walk to Beautiful and second your recommendation. It is very inspiring to see the young women with this plight be given a second chance.

[valkyrie607]

Her husband raped her. Please don't use the relatively benign-sounding euphemism. It was rape.

[jessicadevyn]

What a strong, courageous, and beautiful young woman Dima is. She has gone through so much in her short life.

Of course marrying off children is one. That's not even an issue open for debate. But nothing will change Until the US and other developed countries actually starts to invest in developing economies. I am not talking about "aide" though that is helpful at the moment. The West needs to invest in infrastructure and not have a monopoly on food in these countries. In this sense, China is well past the States.

Microloans are another fantastic and constructive tool that does help.

[escribacat]

In the long run, microloans are probably more helpful than aid -- they go directly to a real person (instead of of some corrupt official taking a cut) and they help that person achieve financial independence.

[inorbit]

Oh, yeah - but remember abortion is NOT an option!

All pregnancies must come to term no matter what the cost is to the mother.

Well, at least that is what you believe if you are a Republican.

[minimalist syntax]

This story is so not about abortion.

[inorbit]

I am referring to the Repugs who oppose family planning aid to countries that might promote abortion as one of the options. This an example of a country in which a safe, legal abortion might be an option for a woman like Dima. But, if it were offered ( and I know it isn't in Ethiopia) the Repugs would be opposed to it. Because after all, a fetus is more important to them than the life and health of a woman.

[paigecl]

Abortion remains a non-option in Ethiopia, not because of religious and social attitudes, but instead, because of a broken and inadequate health care system. Ethiopia, lodged firmly in the 3rd world, routinely logs deaths due to malaria, TB, and dental abcesses. If the health care system can't deal with a diseased tooth, I can't imagine access to abortion is likely either.

[ROSAGrids]

You dont want to know about 'Traditional Doctors' who help woman to terminate their pregnancy. Many sad stories...Untrained persons pause as a specialist to do abortion. A number of lives have been lost in this front as well.

[fattine]

Ethiopia is not in the third world. Ethiopia is the First World. Ethiopia is the original home of all humankind. Ethiopia was in the beginning at the foundation of the creation of the world. This third world crap is a Euro-Centric concept of the world. By the way where is the Second World and whose in it?