Rural women bear obstetric fistula’s brunt

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Pascalinah Kabi

SHE could have easily carried the mantle of the beauty of the plateaus of Semonkong, a tiny remote town 115km into the heart of Lesotho’s mountain ranges, but 17 year old Ntšepeng (not her real name) died an outcast shunned by her entire village.

Her well-sculptured face and big white eyes complemented by a wide sparkling smile made the lanky teenager the envy of her peers and a trophy wife that was desired by all the men in the area.

But fate had picked out a different, sinister and tragic turn of events for Ntšepeng who was diagnosed with the dreaded obstetric fistula after giving birth to her first child and she died in late last year.

Obstetric fistula is a medical condition in which a fistula (hole) develops between either the rectum and vagina, the ureter and the vagina, or between the bladder and vagina after prolonged, severe or failed childbirth.

According to the World Health Organisation (WHO), “Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems”.

“It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.

“The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour,” WHO says on its website.

Obstetric fistula is common in the Mokhotlong district.

Raised in a poor family, Ntšepeng strongly believed that education was key to improving her family’s livelihood and wanted to complete her secondary education and to enroll at the National University of Lesotho (NUL) as a step to a good future.

But this was not to be after her family married her off to a Semonkong man who works as a miner in South Africa in 2014.

She was only 15 years old at the time.

“She pleaded with her family not to marry her off and she cried herself to sleep on a daily basis begging to be given an opportunity to complete her studies.

“Her pleas fell on deaf ears,” said a neighbour who spoke on condition of anonymity.

The neighbour added: “Both her family and that of her suitor hatched a plan to have a man and his friends abduct her and violate her on her way to in-laws’ house.”

Within two days of her ‘abduction’, the source said, news that young Ntšepeng had been abducted (in line with the traditional chobeliso custom) spread throughout the village and everyone was ‘happy’ for her.”

The United Nations Children’s Fund (UNICEF) says that two percent of married women were married off on their 15th birthday while 19 percent got married at 18 years as per the Demographic and Health Survey Report of 2009.

The latest Demographic and Health Survey Report of 2014 released in 2016, however, states that 17.7 percent of girls aged from 15 to 19 years were married while only a mere one percent of boys on the same age were married.

The perception in the village was that Ntšepeng had married into a good family and to a good man who would pay the traditional bridal price and take care of her needs.

“She has escaped poverty”, they said.

As is the case with all new wives, both families secretly wished for Ntšepeng to fall pregnant and when she started having morning sickness her mother-in-law shared the news with everyone who cared to listen – much to Ntšepeng’s dissatisfaction.

She gave birth to a healthy baby girl “but few months later, something was noticeably wrong with her as she began to keep to herself, waking early in the morning to bath, do household chores, bath again and spend most of the day sitting with her child behind the family’s hut”.

“Rumours began doing the rounds that she had an odour emanating from her vagina.

“Her husband also stopped coming home every month end and now sent money through her mother-in-law, who despised Ntšepeng for having a smelly vagina,” the neighbour said.

The shuttling between medical and traditional doctors proved an exercise in futility and Ntšepeng, the young girl-turned mother breathed her last in December 2016.

“Death saved her from a very miserable life,” the source said.

Independent Midwives Association of Lesotho President, ‘Mapitso Matsoha, said while she could not say whether or not Ntšepeng had fistula, there were “many cases of fistula in Mokhotlong and these were diagnosed late at health centres during labour”.

“I urge anyone with fistula to quickly report at health facilities for clinical surgery procedures to correct that hole. Mothers are trained on such matters during pregnancy and they should be able to pick it up very quickly,” Ms Matsoha said.

For teenage mothers, risks of having obstetric fistula are higher as their pelvic tissue has not fully developed and prolonged unattended labour increases their chances of having a hole between their vagina and bladder or rectum.

The United Nations Populations Fund (UNFPA) says obstetric fistula affects an estimated 50 000 to 100 000 women world-wide and the condition is common in sub-Saharan countries like Lesotho where populations face challenges of obtaining quality healthcare.

UNFPA  Executive Director, Babatunde Osotimehin

During the International Day to End Obstetric Fistula on May 23, themed “hope, healing and dignity for all”, UNFPA  Executive Director, Babatunde Osotimehin, said “ending fistula is a high priority for UNFPA and it is a key step on the road to achieving the world’s Sustainable Development Goals by 2030.”

Dr Osotimehin added: “Fistula has been virtually eliminated in the world’s wealthier countries, so we know that it can be eliminated in every country. Strong health systems and greater efforts to address the underlying issues that perpetuate it, including poverty, gender inequality, early marriage and childbearing, and lack of education, are crucial.”

He said working with their partners, the UNFPA had made progress towards eliminating fistula through prevention, treatment and social reintegration.

“It doesn’t have to be this way. With strong political leadership, investment and action, we can end this scourge in our lifetime.”

Dr Osotimehin pleaded with all stakeholders to collaborate with UNFPA in supporting the world’s poorest, most marginalised women and girls.

Child marriage is one of the contributing factors to the high numbers of fistula cases.

Deputy Minister of Health and legislator ‘Manthabiseng Phohleli, has been very vocal about the need to end child marriages.

In 2016 she pleaded with the 9th parliament whose tenure came to an abrupt end in March this year to outlaw child marriages.

In July 2016, parliament adopted a resolution calling on government to step up efforts to end child marriages by reforming marriage laws and other policies.

The resolution was made after Ms Phohleli revealed that statistics from the Ministry of Social Development had shown that at least 1 742 girls were married before the age of 18 in 2016 while at least 1567 adolescents dropped out of school due to pregnancy in the period.

Ms Phohleli said the time had come for the government to intensify efforts to end child marriages by reforming marriage laws and related legislation to ensure they were in line with international and regional human rights instruments.

“What is also shocking is that 40 percent of underage girls in the Southern African Development Community (SADC) region go into early marriages. According to UNICEF, 19 percent of underage girls in Lesotho entered into child marriages.

“We need to fight for the rights of these children by ensuring that laws are put in place to protect them. Child marriages have many negative consequences for this nation,” Ms Phohleli said, adding, marriage laws had to complement, rather than contradict each other.

She added that the customary Lerotholi Laws in Lesotho state that if a child is raped, the decision to sue the perpetrator lies solely with the parents who might decide to negotiate with the abuser.

“The truth of the matter is we hide these atrocities in the name of culture, hence my call for this house to enact laws that will prevent child marriages,” Ms Phohleli said.

While Ntšepeng and many other young Basotho women paid the ultimate price at the hands of their parents, the SADC Parliamentary Forum has given renewed hope to many young African girls.

At its sitting in Swaziland last year, the forum adopted the Model Law on Eradicating Child Marriage and Protecting Children Already in Marriage which requires member states to harmonise their national laws to prevent child marriages in support of the African Union Campaign to End Child Marriage in a Generation.

The Model Law seeks to eliminate several loop holes, like in the Lesotho case, that make current laws ineffective and unenforceable including parental and judicial consent, and conflicts between customary and statuary laws.

It remains to be seen whether the current parliament will domesticate the Model Law to protect and ensure that children will not be victimised by traditional practices like Ntšepeng and so many others.

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