This series of blog posts provides an overview of Nicholas D. Kristof and Sheryl Wudunn’s Half The Sky; How to change the world. The posts will address 6 main gender issues drawn directly from the book and explore organisations dealing with these issues around the world. The book makes for uncomfortable reading in places but it is an important one, being described as ‘a manifesto for advancing freedom for hundreds of millions of human beings.’
The areas covered in the book include obstetric fistulas and maternal healthcare, rule by rape, honor killings, sex trafficking, female genital cutting and educational inequality. None of these issues are easy ones to tackle and the book is not just a compilation of facts and figures; it explores the root causes of these issues, as well as drawing our attention to how it is affecting millions of women worldwide. Moreover, the book is unapologetically critical of how we are currently dealing with these issues and on many occasions presents sound ideas for future development.
My hope for this series of blog posts is to provide an overview of these issues and to provide a place for open discussion on these topics. The importance of these issues cannot be overemphasised; millions and millions of women worldwide are being enslaved, trafficked, face terrifying and dangerous childbirths, are downtrodden, held back from education and sadly, commonly, simply disappear off the face of the earth every day without a trace. This is not just a gender problem. This is a humanitarian problem.
1. Obstetric fistulae
Relatively unheard of in developed countries and scarcely reported on, obstetric fistulas pose an immense threat to many women across the globe, especially in sub-Saharan Africa and Asia. These obstetric fistulas are holes formed in between the vagina and the bladder or rectum, caused by obstructed labour and lack of medical care during childbirth. Pressure against the birth canal, often caused by the baby’s head becoming stuck, leads to the restricted or completely halted bloody supply to that area, in turn causing the affected tissue to rot away.
The number of women who suffer from this debilitating consequence of labour is startling. Obstetric fistulas are most common in sub-Saharan Africa and Asia, with more than 2 million women living with untreated fistulas in these two regions alone.
Half The Sky tells the story of Mahabouba Muhummad, who grew up in Western Ethiopia. The divorce of her parents lead to her being handed over to her father’s sister, but after being treated as a servant by him she ran away to work in a town as a maid in exhange for room and board. She was subsequently, at the age of 13, sold for eighty birr (ten dollars) against her will and impregnated by the man who bought her to be his second wife. Beatings were a common feature of Mahabouba’s life even whilst pregnant and after fearing for her and her baby’s life she fled to the local town. There she found that no one would help her and eventually ended up residing in a small hut by an uncle’s house in order to keep herself and her baby alive.
After enduring a seven day labour alone, Mahabouba eventually fell unconscious and when she came round found that her baby had been wedged inside her birth passage for so long, the tissue between the baby’s head and Mahabouba’s pelvis had lost circulation and the tissue rotted away. Mahabouba was 14, and her pelvis had not yet grown large enough to accommodate the baby’s head.
This is a common plight for many girls under 15. Dr Waaldijk, a surgeon working in Babbar Ruga Hospital in rural Nigeria, says that more than a third of his fistula patients are 15 or under, with records indicating that they were married aged 11 or 12.
‘The reason these women are pariahs is because they are women. If this happened to men, we would have foundations and supplies coming in from all over the world.’
Mahabouba’s horrific story does not end there. After enduring a terrifying and solitary childbirth and losing her baby, Mahabouba was ostracised by her community. Unable to walk or even stand due to the nerve damage caused by the fistula, she was taken to a hut on the edge of the village, the doors taken off, where she was left to be eaten by hyenas. To the village, Mahabouba was cursed and this had to be her fate.
Ruth Kennedy, a British nurse-midwife working at the Addis Ababa Fistula Hospital where Mahabouba was eventually treated, describes fistulas patients as ‘the modern day leper…She is helpless, she’s voiceless…The reason these women are pariahs is because they are women. If this happened to men, we would have foundations and supplies coming in from all over the world.’
The extent to which these fistulas can destroy a women’s body cannot be overemphasised. They leave women entirely incontinent, their bodies leaking urine and faeces. Fistula victims are frequently divorced by their husbands who are unable to cope with the terrible smells emitting from their bodies, and like Mahabouba, are often completely ostracised by their communities. According to Medecins Sans Frontieres, women will often reduce their liquid intake in an attempt to reduce the flow of urine, which can result in kidney disease and bladder stones. In other cases, these women will quite simply starve to death.
Simeesh Sagaye, a fistula victim who also features in this book, was also unable to receive medical attention after a two day long obstructed labour. Abandoned by her husband, her parents were left to care for her and whilst they supported her, even they struggled to cope with the stench that came from her body – building her a separate hut on the side of their house for her to live in. The psychological damage that can come in part from such isolation is immense. One estimate finds that 90 percent of fistula patients have contemplated suicide, and Simeesh was one of these women. For two years, Simeesh laid curled up in the fetal position in her hut, depression taking over her life. Eventually, thanks to her family selling their entire livestock and assets, Simeesh’s family were able to pay for a private driver to transport Simeesh to a hospital to receive medical attention.
‘The American government allocates only a twentieth of 1 percent of the amount that they spend on their military, to maternal health. This is an inexplicably neglected global issue.’
On arrival at the hospital, the doctors found that Simeesh’s body was wrecked from having been laying this way for so long and it took months of physical therapy, a temporary colostomy (owing to centimetres of her pubic joint that had disappeared due to infection), and intensive physiotherapy and massage before Simeesh could stand again. Finally, Simeesh was ready to have the fistula surgery that would lead to her complete and full recovery.
Both of these harrowing stories highlight a startling problem in global maternal healthcare. Not only can obstetric fistulas completely blight the futures of survivors, but obstructed labour is responsible for up to 6% of all maternal deaths. In Half The Sky, Nicholas D. Kristof and Sheryl Wudunn call for a global campaign to save mothers in childbirth. Despite a Millennium Development goal that focused on maternal health, the World Health Organisation says that between 1990 and 2015, the global maternal mortality ratio (the number of maternal deaths per 100 000 live births) declined by only 2.3% per year. In Niger, a girl or woman stands a 1 in 7 chance of dying in childbirth. Compare this to Poland’s 1 in 19,800 lifetime risk, Italy’s 1 in 26,600 and Ireland’s impressive 1 in 47,600 lifetime risk of dying in childbirth, and serious questions should be asked about why maternal health in certain parts of the world faces such extreme neglect.
It suprises many to find that vaginal fistulas can be successfully closed with simple surgery in approximately 80-95% of all cases. The problem is overwhelmingly simple to solve. And though many might ask how a global campaign can be funded, consider that the American government allocates only a twentieth of 1 percent of the amount that they spend on their military, to maternal health. This is an inexplicably neglected global issue.
Mahabouba’s story, though, does have a happy ending. She survived that night alone in the hut, fending off hyenas all through the night with a stick and when daylight came she was able to drag herself by her arms to the next village for help. There she was taken in by a Western missionary, who found her on their doorstep half dead. Although her fistula was too severe for her to undergo fully restorative surgery, Mahabouba was able to be fitted with a colostomy which enabled her to live again. Mahabouba, needing to reside at the hospital so that she may be properly cared for, initially started working changing linen or helping to wash patients, but a renewed passion for life saw strive for greater things. She learned to read and write and against all odds, Mahabouba climbed the ranks to become a senior nurses aide at the Addis Ababa Fistula Hospital, the very one that had saved her life.
Most of this information was drawn from Half The Sky; How to change the world by Nicholas D. Kristof and Sheryl Wudunn
Further sources include: