I think this is a very interesting idea, and I think the concept of empowering fistula survivors to make change in their communities is an excellent ideas.
A few questions:
1) How will the women work to change the cultural factors that contribute to obstetric fistula? Will their training include work on gender equality and women’s empowerment? Changing longstanding attitudes about gender inequality is not easy, so more information about who you intend to reach out to and affect would be good here. For example, would you work with community leaders or parents to educate them about the dangers of forced marriage?
2) I would encourage you to broaden the scope of reproductive services beyond family planning. For instance, many women are married to much older (and more sexually experienced) men who may or may not have an STI. Women should be given information about the full range of reproductive health services they need beyond family planning and maternity care.
3) What action steps do you think are necessary to end early and forced marriage? Access to education? Community education programs?
I think this idea is great and could potentially really help these women, however, I have some questions about how you think it will be recepted.
If these women are already ostracized from their community, is there going to be a problem getting people to actually go to a health center run by them? Are these women ostracized because because they are belittled or is there some belief that something is now inherently wrong with them?
Thank you so much for your comments. I appreciate the feedback and questions. I started with a short background on fistula.
Quick Background on Fistula: An obstetric fistula is a tear between the vagina and bladder, urethra or rectum that occurs during childbirth. The result: incontinence and a broken spirit. Girls as young as 13 experience obstetric fistulas. A fistula occurs because the girl’s body is not fully developed and/or malnutrition and therefore is incapable of giving a successful birth. Often times, these young girls give birth on their own or with untrained traditional birth attendants. The consequences of obstetric fistula can leave a girl physically impaired, emotionally scarred, psychologically damaged and socially ostracized. Lack of obstetric care plays a significant role- currently only 1 midwife per 60,000 women but child marriages are the primary cause of fistula. Approximately 2 million women have untreated fistula, 100,000 women develop fistula each year, and 800,000 die.
To answer the questions:
Obstetric fistula is not a disease, but a medical condition correctable by surgery. It is true that much of the developing world measures a woman’s worth by the number of offspring she can provide and her value as a wife. Therefore, when a woman suffering from an obstetric fistula is ostracized because she does not meet the standards, one can see why she may not want to or is not allowed to return to her village. However, this is not the only reason fistula-sufferers are shunned. Obstetric fistula leaves women incontinent (urine, feces or both). Due to her incontinence, she cannot stop the foul odor that begins to permeate from her body. She often times is moved to an isolated part of the community where she lives as an outcast until she dies. This is also part of the reason why current statistics are not accurate. Most women living with fistula live in isolation and shame. They do not understand that the problem they are experiencing can be corrected. Often times, the nearest hospital is over a ten day trek—and that is not a long journey in some places. It is not hard to see why a lot of women do not step forward. Therefore, once our women complete the midwife training program they will be given an option as to where they want to work. We believe this will allow women to regain their dignity and confidence. I would like to point out however that not all fistula survivors are rejected by their communities. Some women have returned home healed and have been welcomed. It is also these women that re-experience fistula and find themselves going back for a second surgery. We hope our community programs will provide other alternatives. Mimidae’s main focus however is to provide opportunities for those that cannot or will not return to their villages.
Our implementation program begins with community building and community mobilization. While the women are in training, our focus is to create awareness and gain trust from communities we intend on working with. Through educational programs and incentives, we will teach the community about the dangers of early marriages both on the female as well as the community. Because child marriages are unquestionably linked to poverty, it is equally important to focus on building economic status; for example, providing scholarships to cover tuition and books and job opportunities for girls. This will delay marriage at least until the girl is 18. The International Center for Research on Women explains, “Expanding opportunities for girls and young women can help change social norms that view marriage as their only option, particularly in cultures where bride price and dowry are common”.
Mimidae does not want to push programs into communities but rather build community and keep members involved in the process. To ensure our program will be successful, we initially identified objectives and priorities broken into three categories (both long and short term progress): gender equity & equality, socio-economic progress and sustainability. In each, community leaders and members expressed their priorities, concerns and socio-economic needs ranging from the general (i.e. better income, employment) to more specific (i.e. clean drinking water, fuel wood). The aim was to get a holistic picture of a community’s needs to assist us in planning programs. (While our programs are completely scalable, each can be tweaked to the more specific needs of a community). (A post-implementation program audit will also be carried out using specific indicators to test our objectives and make necessary adjustments).
Initially, our programs will be serving in a limited capacity until Mimidae receives more funding. Our family planning program will provide services such as health and hygiene awareness, STD/STI awareness and testing, contraception options, encouraging women’s full participation in society, creating opportunities for education and employment, and raising awareness of women’s rights. One of our primary goals is to work with young girls who have already married. In international efforts to delay and prevent child marriages, the girls that have been married off are often forgotten. Mimidae’s family planning service will help educate them on the importance of spacing out their pregnancies, dangers of sexually transmitted diseases and infections as well as better infant health care options.
I hope I have answered all the questions. Look forward to hearing your feedback!
Comments
Yeabsi,
I think this is a very interesting idea, and I think the concept of empowering fistula survivors to make change in their communities is an excellent ideas.
A few questions:
1) How will the women work to change the cultural factors that contribute to obstetric fistula? Will their training include work on gender equality and women’s empowerment? Changing longstanding attitudes about gender inequality is not easy, so more information about who you intend to reach out to and affect would be good here. For example, would you work with community leaders or parents to educate them about the dangers of forced marriage?
2) I would encourage you to broaden the scope of reproductive services beyond family planning. For instance, many women are married to much older (and more sexually experienced) men who may or may not have an STI. Women should be given information about the full range of reproductive health services they need beyond family planning and maternity care.
3) What action steps do you think are necessary to end early and forced marriage? Access to education? Community education programs?
(Read Below)
I think this idea is great and could potentially really help these women, however, I have some questions about how you think it will be recepted.
If these women are already ostracized from their community, is there going to be a problem getting people to actually go to a health center run by them? Are these women ostracized because because they are belittled or is there some belief that something is now inherently wrong with them?
(Read Below)
Thank you so much for your comments. I appreciate the feedback and questions. I started with a short background on fistula.
Quick Background on Fistula: An obstetric fistula is a tear between the vagina and bladder, urethra or rectum that occurs during childbirth. The result: incontinence and a broken spirit. Girls as young as 13 experience obstetric fistulas. A fistula occurs because the girl’s body is not fully developed and/or malnutrition and therefore is incapable of giving a successful birth. Often times, these young girls give birth on their own or with untrained traditional birth attendants. The consequences of obstetric fistula can leave a girl physically impaired, emotionally scarred, psychologically damaged and socially ostracized. Lack of obstetric care plays a significant role- currently only 1 midwife per 60,000 women but child marriages are the primary cause of fistula. Approximately 2 million women have untreated fistula, 100,000 women develop fistula each year, and 800,000 die.
To answer the questions:
Obstetric fistula is not a disease, but a medical condition correctable by surgery. It is true that much of the developing world measures a woman’s worth by the number of offspring she can provide and her value as a wife. Therefore, when a woman suffering from an obstetric fistula is ostracized because she does not meet the standards, one can see why she may not want to or is not allowed to return to her village. However, this is not the only reason fistula-sufferers are shunned. Obstetric fistula leaves women incontinent (urine, feces or both). Due to her incontinence, she cannot stop the foul odor that begins to permeate from her body. She often times is moved to an isolated part of the community where she lives as an outcast until she dies. This is also part of the reason why current statistics are not accurate. Most women living with fistula live in isolation and shame. They do not understand that the problem they are experiencing can be corrected. Often times, the nearest hospital is over a ten day trek—and that is not a long journey in some places. It is not hard to see why a lot of women do not step forward. Therefore, once our women complete the midwife training program they will be given an option as to where they want to work. We believe this will allow women to regain their dignity and confidence. I would like to point out however that not all fistula survivors are rejected by their communities. Some women have returned home healed and have been welcomed. It is also these women that re-experience fistula and find themselves going back for a second surgery. We hope our community programs will provide other alternatives. Mimidae’s main focus however is to provide opportunities for those that cannot or will not return to their villages.
Our implementation program begins with community building and community mobilization. While the women are in training, our focus is to create awareness and gain trust from communities we intend on working with. Through educational programs and incentives, we will teach the community about the dangers of early marriages both on the female as well as the community. Because child marriages are unquestionably linked to poverty, it is equally important to focus on building economic status; for example, providing scholarships to cover tuition and books and job opportunities for girls. This will delay marriage at least until the girl is 18. The International Center for Research on Women explains, “Expanding opportunities for girls and young women can help change social norms that view marriage as their only option, particularly in cultures where bride price and dowry are common”.
Mimidae does not want to push programs into communities but rather build community and keep members involved in the process. To ensure our program will be successful, we initially identified objectives and priorities broken into three categories (both long and short term progress): gender equity & equality, socio-economic progress and sustainability. In each, community leaders and members expressed their priorities, concerns and socio-economic needs ranging from the general (i.e. better income, employment) to more specific (i.e. clean drinking water, fuel wood). The aim was to get a holistic picture of a community’s needs to assist us in planning programs. (While our programs are completely scalable, each can be tweaked to the more specific needs of a community). (A post-implementation program audit will also be carried out using specific indicators to test our objectives and make necessary adjustments).
Initially, our programs will be serving in a limited capacity until Mimidae receives more funding. Our family planning program will provide services such as health and hygiene awareness, STD/STI awareness and testing, contraception options, encouraging women’s full participation in society, creating opportunities for education and employment, and raising awareness of women’s rights. One of our primary goals is to work with young girls who have already married. In international efforts to delay and prevent child marriages, the girls that have been married off are often forgotten. Mimidae’s family planning service will help educate them on the importance of spacing out their pregnancies, dangers of sexually transmitted diseases and infections as well as better infant health care options.
I hope I have answered all the questions. Look forward to hearing your feedback!