Maternal mortality ratios are a strong reflection of the overall effectiveness of a country's health systems, and in Malawi the lifetime risk of maternal death is one in 34.
Maternal mortality ratios are a strong reflection of the overall effectiveness of a country’s health systems, and in Malawi the lifetime risk of maternal death is one in 34.
In contrast, the lifetime risk of death for expectant mothers in India is one in 190, and in Sweden the odds improve to one in 13,600 (UNICEF).
In Malawi, access to quality maternal services is a challenge due to issues such as long distances some women have to walk to facilities and lack of trained midwives. As a result, even for mothers who survive giving birth, health complications are common.
One of the most serious conditions women may suffer after giving birth is obstetric fistula. This is a physically and psychologically devastating condition that results from an injury to the pelvic organs when a woman experiences a long and obstructed labour. Following this, tissue damage in the birth canal can cause constant leaking of urine or faeces out of the vagina.
Accessing fistula repair services
Enock Phiri, 28, is a young man who is helping women access free fistula repair surgeries and education where it is difficult to access such services, with support from Freedom From Fistula Foundation.
Enock lives in the hard-to-reach rural area of Matekenya Village, in Traditional Authority Msakambewa, Dowa District – a round trip of 170 kilometres to Malawi’s capital where there is the country’s only fistula care centre. Despite the distance he has managed to bring 15 women to the hospital to ensure they are accessing the fistula services they need.
Enock got involved in this voluntary work because his own sister Beriverio Phiri, 40, was living with an obstetric fistula condition. He brought her to the centre where she was treated after suffering for four years. Enock and his sister later took a leading role in bringing awareness on prevention and care of the disease in their community.
Women with fistula often face stigma and social exclusion. And for those who may have also learned during their pregnancy that they are living with HIV, the discrimination they face can be doubled.
Margaret Moyo is the national coordinator for the Fistula Care Centre at Bwaila Hospital in Malawi’s capital Lilongwe, which has 35 beds. She says some women are divorced by their husbands due to their condition and not only face the trauma of their health issues, but also the burden of rearing children alone.
Moyo adds: “The double stigma experienced by HIV positive women with fistula increases the likelihood that they will endure gender-based violence. Often, these women are viewed as being to blame for their condition and less able to fulfil their ‘role’ as women in the household, resulting in poor treatment from their partners.”
In Malawi, there are no official statistics on fistula to date, although the Ministry of Health is working on this. According to records at Bwaila Fistula Centre, every year close to 250 women receive treatment for fistula there although the extent of the problem in the country may be far greater.
Restoring family ties
Matilida Henderson, 35, was another woman suffering with fistula who was helped by Enock. Before getting treated her husband used to call her disgusting and he came close to taking another wife.
Matilida said: “My husband is now a changed person. He realised that fistula is curable and preventable after I was repaired at Bwaila. I would really thank Enock’s effort in facilitating my movement to the Fistula Care Centre.”
National coordinator Moyo also praises Enock’s actions. She said: “It is possible that men can take part in tackling fistula. We are calling upon all men in the country to emulate Enock Phiri’s example. It is not Enock who got sick but he brought a sister and other women. This is really amazing, he is our ambassador and we will keep on talking of his involvement.”
Improving maternal health services
In September, global leaders gathered in New York at the United Nations 70th Session of the General Assembly to adopt 17 new sustainable development goals.
To achieve goal number three on ensuring healthy lives for all there must be a strong focus on improving maternal health services, and it will take a concerted effort from people at every level working together, from the community up to government.
Enock is already doing his part by helping to end discrimination and violence against women, especially fistula patients. Now let’s see if the global leaders can deliver on their commitments over the next 15 years.
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