Fistula, child marriages: The stinky affair

Roselyne Sachiti Features Editor
When she was forced to marry a 35-year-old man, whose name she did not know, but had met twice at their Johanne Marange church shrine, Rosemary Kashinda (15) from Chief Makumbe area in Buhera cried bitterly. She despised everything about her new husband whose name she learnt was Moses, a day before she was handed over to him.

The idea of sleeping next to a man with small beady eyes, crooked front teeth and a long beard upset her.

She despised the way he called her name. Her Form 1 teacher whose intelligence she admired called her Rose, and Moses called her Rozie. She hated Moses for taking away her dream of becoming a teacher, too, and even making her own choice of marrying an intelligent man like Mr Gonzo.

On December 19, 2015, her two paternal aunts, she identified as Mai Eliza and Mai Beulah accompanied her to her new husband’s home.

“I slowly walked behind them holding my small bag and crying. I pictured Mai Beulah, my obese aunt who walked with a limp being attacked by hyenas as she could not run.

“This at least was punishment for their failure to protect me from being pushed onto the marriage bed when I still wanted to be in school. My mother is the only one who refused but no one listened to her,” Rosemary told The Herald Review recently.

She said she wrote everything in a small book she put in a small plastic and stashed in their vegetable garden, a skill she learnt at school.

“When my aunts left, I cried and could not eat. At 16, I became pregnant. I was not ready to be a mom. I cried because my breasts had not fully developed and thought they could not lactate. I thought that my stomach would burst. I worried that the baby would, like my six month-old sister, cry all night or die from measles,” she said.

Because of their religious beliefs, she did not go to their local clinic for prenatal care. Elderly women from her church would assist her deliver her baby at home.

“I was in labour for three days. They told me my baby was lazy and would eventually come. They said I should be patient yet the pain was excruciating. They told me to push. I kept pushing but no baby came. I thought I would die, but I hung on because I wanted to tell my story one day,” she said.

After an intense labour, she gave birth to a dead baby girl.

Her nightmare begun.

“I could see urine and faeces dripping from my panties. I was not sure why this was happening and the elderly women who helped me deliver had not prepared me for this. I used a cloth to reduce leaks. I could smell the odour from my body. Everywhere I went, people moved away from me. I was worried and cried,” she said.

She kept her secret for two months.

Her marriage also suffered.

“My husband wanted to become intimate and I could not because of my condition. He hit me and told me that he would make me eat my faeces if they continued to drip. My mother-in-law banned me from cooking. I would spend my days in a vegetable garden from where I received my meals. I eventually left the marriage,” she explained.

Back at her parent’s home, her mother told a neighbour who is also a community health worker to accompany her to the local clinic. Her mother did not want other church members to see her at the clinic.

“They told me it was fistula. It was my first time to hear such a word. I recited it as the nurse referred me to Mutare General Hospital since I had developed an infection. I was told to go to Parirenyatwa Hospital in Harare where the infection was treated. I received corrective surgery last year and now happy,” she added.

Fistula is a hole between the birth canal and the bladder or rectum caused by prolonged obstructed labour without timely access to emergency obstetric care, notably caesarian section. It leaves women leaking urine, faeces or both and over time, it leads to chronic medical problems like frequent infections, kidney disease and infertility.

Young brides like Rosemary are one of the populations most vulnerable to fistulas.

Child marriage remains a global challenge.

An estimated 14 million girls are given out in marriage before they turn 18, some as young as 9.

The “stinky affair” of a young girl indulging in sexual activities, conceiving and giving birth when her body is not developed enough accounts for at least 25 percent of known fistula cases.

According to United Nations Population Fund Country Representative Mr Cheikh Tidiane Cisse, obstetric fistula remains a huge problem, especially in developing countries.

In Zimbabwe, he said, complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive health (15-49) years.

“Obstetric fistula occurs mostly among women and girls living in extreme poverty, especially those living far from medical services.

“It is also more likely to afflict girls who become pregnant while still physically immature. “Women with fistula are unable to work, and many are abandoned by their husbands and families and ostrasised by their communities driving them further into poverty,” he said.

He added that reconstruction surgery can usually repair fistula, yet those affected by this injury often do not know about treatment, cannot afford it and neither can they reach health facilities where treatment is available.

Through collaborations, UNFPA and its partners like the Women and Health Alliance International (WAHA) has been supporting Zimbabwe’s Ministry of Health and Child Care in addressing the fistula problem.

“To date, a total of five fistula repair camps have been conducted and over 300 women have benefited from these fistula repair camps and over 500 women are on the waiting list. In addition, a total of 12 doctors and 46 nurses are receiving training in pre and post operative management of obstetric fistula through a mentorship programme led by WAHA.

The United Bulawayo Hospitals is currently being renovated as a second fistula repair centre to cater for the southern region of the country,” he added.

Obstetric fistula has been eliminated in industrialised countries by availability of treatment for prolonged obstructed labour typically C-sections.

In Zimbabwe, many women in rural areas face challenges of living far from health facilities.

“Investment in maternity waiting homes that help bring women closer to health facilities is key.

Since 2012 UNFPA has worked with the Ministry of Health and Child Care to revitalise at least 120 maternity waiting homes to ensure women, particularly those in remote rural areas are closer to health facilities.

“In addition, providing family planning to women could reduce maternal disability and death by at least 20 percent. We must address the underlying issues such as early, marriage and childbearing that put young girls at risk of suffering birth injuries such as fistula.

Zimbabwe’s maternal mortality rate remains high at 651 deaths per 100 000 live births, which translates to about eight women dying every day of pregnancy related complications according to the Zimbabwe Demographic Health Survey 2014.

It is estimated that for every woman who dies due to pregnancy related causes another 20 to 50 suffer severe morbidities such as obstetric fistula, one of the most serious and tragic injuries that can occur during childbirth,” Mr Cisse added.

Political leadership is also speaking out against early child marriages which lead to complications like obstetric fistula during pregnancy.

Mashonaland West Minister of State for Provincial Affairs, Faber Chidarikire believes the inter linkages between poverty, malnutrition , lack of or inadequate or inaccessible health care services , early child bearing , child marriage , violence against young women and girls and gender discrimination are the root causes of obstetric fistula.

“Child bearing increases the risk of complications during pregnancy and delivery and entails a much higher risk of maternal mortality and morbidity,” he said.

He added that the continued occurrence of obstetric fistula is a human rights tragedy, reflecting the marginalisation of those affected.

“Their isolation means they often go unnoticed by policy makers, and as a result, little action is taken to address or prevent the condition,” he added.

In Zimbabwe, he explained, there are concerted efforts to prevent obstetric fistula such as availability of health facilities within a 10km radius of the majority of the population, capacitation of health workers in provision of emergency obstetric care provision of life saving commodities for women, high levels of health facility based deliveries and skilled birth attendance rates.