News/Publications

Violence against women

 Violence against women may be caused by commission e.g genital mutilation or sexual assault during times war or through domestic abuse, all of which have in recent years received the attention of civil society. Equally, however, violence against women may be perpetrated by omission in particular e.g. neglect during pregnancy and childbirth.

Maternal Mortality
Women (mothers), in the developing world, are experiencing “unimaginable suffering” and the scandalous lack of effective care during pregnancy and childbirth is resulting in almost 600,000 dying annually. Ninety-nine per cent of these deaths occur in developing countries. Thus the risk of a women dying in Africa is 1: 13, whereas the risk in Belgium is 1: 5,600 and in Canada 1: 8700. It is no exaggeration to say that this is one of the most neglected tragedies of our times.

These deaths do not take place in a visible and concentrated way, but occur in poor countries, among very young women, in small villages, and a few at a time. Many are refugees who like everyone else have to endure the terrors of bombs and guns but also the results of civil wars e.g cholera, added to which are the endemic diseases e.g. malaria and malnutrition etc but in addition as many are pregnant they have nowhere to go for prenatal care and safe clean delivery or trained midwives or doctors. Thus the poor and displaced die in terror from haemorrhage in agony from obstructed labour as their pelvises are too small or from various infections. Not only are the lives of these women abruptly terminated but also the chances of survival of the young children they leave behind, decreases dramatically. Thus the family itself disintegrates in the aftermath of the mother's death, which has serious consequences for their villages and tribal communities.

Worldwide, annually there are estimated to be 200 million pregnancies, most of which occur to women who wish to become mothers. All are optimistic and look forward to the birth of their babies. Death therefore during pregnancy is far from their consideration. Once dead they have no voice and cannot speak about their suffering. MCI terms this tragedy the “Silent Tsunami”.

Maternal Morbidity
(Obstetric fistula) Deaths from childbirth related causes represent only the tip of the iceberg. It is estimated that for every death, 30 more suffer long-term damage to their health, most commonly from obstetric fistulae. These arise in very young mothers, aged 14 - 20 years, as a consequence of neglected obstructed labour and frequently from cultural practices e.g. female genital circumcision (FMG) and child marriages. The result is that the baby dies and because of damage to the bladder and rectum the mother becomes incontinent of urine and/or faeces (obstetric fistula), and thus becomes a complete outcast and is treated worse than a leper by her spouse, family and society, simply because her condition is offensive to everyone. They suffer pain, humiliation, and lifelong debility if not treated. Worldwide there are 2 million untreated cases mostly in Africa and 100,000 are added annually. The tragedy is that most of this mortality and morbidity is preventable with proper maternity care and obstetric fistula can be treated surgically, but at present there are insufficient trained doctors, nurses or adequate facilities.

Traumatic Gynaecological fistulae
Occurs as a consequence of sexual violence, usually but not always in conflict and post-conflict situations but can also occur in violent domestic situations.

MILLENNIUM DEVELOPMENT GOAL (MDG No 5)

The objective of MDG No 5 is concerned with improving maternal health, by reducing maternal mortality and morbidity, by 75 % by 2015. However, the objectives of all MDGs are not being met but in particular MDG No 5 is the most neglected of all. MDG No 3 concerns empowering women (mothers) but that is not possible unless they survive. This amounts to a massive denial of the human rights of mothers i.e. the right to appropriate health care during pregnancy and childbirth. In short one group of women (pregnant) is suffering serious discrimination.

The problems of women’s health, and the need for improved care has been discussed at the United Nations, the World Health Organisation (WHO), the European Union (EU) and other governments, the international health community and various women’s groups for many years but always in the a bstract thus little has been done. Maternal mortality is not of the same political importance as for example is AIDS simply because in the developed world there are deaths from HIV but rarely from direct pregnancy causes. While millions of dollars are spent on reproductive health programmes (abortion and birth control), only a small fraction is focused on providing essential obstetric services that ensures women survive their pregnancies, services freely available to all women in developed countries.

While genital mutilation through female circumcision has been outlawed in many countries, little has been done about other forms of mutilation i.e. various types of fistulae. It matters little if the mutilation results from cultural reasons or from neglect in childbirth, the injury still results in serious discrimination. WHO has also pointed out that help for these mothers will have to come from developed countries, for the foreseeable future, simply because there is not enough funds for their treatment in health budgets in countries where deaths and fistulae are common. It is an international disgrace that so many poor mothers, especially in Africa, should die having their babies or should have to endure the ultimate of indignities, incontinence, when prevention and treatment are possible.

SOLUTIONS

There must be a balanced approach between prenatal and curative care. Thus demonstration projects are needed by providing; new approaches to essential services especially in rural areas, which are based on local circumstances, are integrated, comprehensive and sustainable e.g. appropriate training for all levels of the health care providers; research into new methods of treatment of complications; and advocacy to empower women and assist African health care professionals to solve these problems.

MATERCARE DEMONSTRATION PROJECTS

MCI has since 1997; Essential Services: Developed in Ghana a model of essential rural obstetrical services based around a small district hospital in Ghana.

Training programmes: Developed essential obstetrics training for doctors and midwives, and special training for traditional birth attendants (TBAs).

Research: Evaluated a new oral, effective, safe and inexpensive treatment for post-partum haemorrhage (PPH), the commonest cause of mortality, which could be used by TBAs.

Fistula care: Has built and equipped a 30 bed specialised fistula care hospital in Ghana with a special interest in training doctors and nurses to be operated by Ghanaian obstetricians and gynaecologists.

Similar obstetrical projects are planned for a rural area of northern Kenya, Sierra Leone and a second 20-bed fistula hospital for Rwanda.

INTERNATIONAL COMMUNITY FUNDING

Overall improvement in maternal mortality and morbidity ratio will only occur if individual women receive appropriate care during pregnancy and childbirth. The former Director General of WHO, Dr. Halfdan Mahler, commented at the first Safe Motherhood Conference in Nairobi in 1987, “We know enough to act now, it could be done; it ought to be done; and in the name of social justice and human solidarity, it must be done.” It is the responsibility of national governments, the international community, including, the United Nations, the World Health Organisation, religious groups, women’s and health organisations to single out this particular tragedy for special concern and action.

Dr R.L. Walley
Honorary Research Professor of Obstetrics and Gynaecology
Executive Director
MaterCare International
Tel: +1 (709) 579-6472 Email: info@matercare.org
International Women’s Day - March 4th 2007