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Kate Gilmore Headshot

Fistula's Youngest Victims

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In my role at the United Nations Population Fund, I have the privilege to travel to urban, rural and remote locations to see the range of efforts being made so that every woman might give birth safely and in dignity, supported by midwives or other skilled attendants. But in many countries, a safe labor and delivery for mother and child is still a lottery -- a roll of the dice. When services are not available, when skilled birth attendants are not in reach, when information is not provided or distance or poverty or discrimination or isolation means a pregnant woman is without access to support, the consequences can be grave, indeed.

One encounter I had with a young girl in Nigeria truly brought home why services to assist pregnant women, and to help women recover when pregnancy brings injury, are so essential. On this occasion, I had the privilege of being shown around a medical facility where women suffering from obstetric fistula are treated. Thanks to transformation enabled through funds from the UNFPA's "Campaign to End Fistula" -- in association with partners such as Johnson & Johnson -- this facility has what is needed to repair and further assist victims of obstetric fistula.

As our convoy pulled into the facility's compound, a group of children gathered around the cars, excited to receive new visitors. Standing just at the edge of this group of kids was a young girl watching them and us closely. As we all moved from the parking area towards the hospital buildings, she followed, keeping her distance; sometimes coming closer, sometimes moving away. If any of us approached her, she would run and hide.

As we moved through the visit, talking with women awaiting or recovering from treatment, she followed -- observing our progress but not willing to approach us. I could not take my eyes away from her, and finally, I asked the medical staff for her story.

That young girl, who was 14 years old at the time, had been married at the age of 10 to a man aged 60. Her parents were convinced that if she were not married by age 11, she would be too old to be appealing. By age 11, she became pregnant. However, her body was not mature enough to carry the pregnancy to term and her baby died. Her reproductive system was also damaged significantly, causing an obstetric fistula that left her incontinent. Her husband's response was to reject her, throw her out of the "marital" home. Her mother, however, brought her to the hospital, where the fistula was repaired.

Tragically, though, no one had ever come back to the hospital to claim that young girl. She had been abandoned -- a year passed and she had nobody, absolutely nobody.

The facility's administration had allowed her to stay in the compound, while successive waves of patients -- in their comings and goings -- had befriended her but then left, too. Thanks to UNFPA's rehabilitation program, which includes livelihood skills, she had learned how to use a sewing machine and had been able to make herself a dress. However, the fact remained that 12 months after the traumatic conclusion to her pregnancy, rejection by her husband and abandonment by her parents, there was no one who offered her care or affection. For at least 12 months, she had not been held, or nurtured, or put to bed, or read a story. Her only meals were through the generosity of random others, for the facility does not have the capacity to feed its patients; they must rely on their families.

So that young girl -- now a young adolescent -- circled our delegation, approaching and withdrawing, just as would a stray animal; just as would any of us who has nowhere to belong, no one to belong to and no where to go.

We might say that to be injured by pregnancy or through birthing at age 25 is extremely sad; that at the age of 30, it is deeply traumatic, or maybe, that at the age of 40, it is devastating. But what words should we apply when pregnancy injures -- for life -- a 10-, 11- or 12-year-old?

As 2015 approaches, we are in the last stages of delivering on the world's millennium development goals, working for ramped-up progress on almost all areas. But the unfortunate reality is that, the goal to reduce maternal mortality has proven one of hardest to achieve --particularly so with respect to young women.

So whenever I find myself thinking about why we need UNFPA; whenever I wonder about to whom UNFPA must be most accountable or by which measure shall UNFPA be judged with regard to our impact and our effectiveness, I think about that young girl. I think about the moment when she finally took hold of my hand and I think about how UNFPA must not let go.