December 2005

ARTICLE TOOLS

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In Ruth Del Fulani's native nigeria, where labor in childbirth can stretch on for a week and trained birth attendants rarely oversee deliveries, her two days of labor seemed routine.

But the toll was horrible. The child's head stuck in her pelvis. This "obstructed labor" cut off blood supply to delicate tissues until the tissues died.

Del Fulani delivered a stillborn baby and then discovered she could no longer control her urine. Del Fulani had suffered a vesicovaginal fistula (VVF), a hole between her vagina and bladder caused by unproductive labor. The fistula left her incontinent and smelling like a sewer.

Obstetric fistula is almost as old as childbirth. It has all but disappeared in wealthier nations, where cesarean sections are readily available during difficult labor.

But VVF remains a complex, intractable health-care problem in the developing world, especially in sub-Saharan Africa. For tens of thousands of women like Del Fulani, the injury becomes the defining moment in their lives. It relegates them to the ranks of the living dead.

Childbirth-related injuries are cruelly effective in destroying a woman's ability to do traditional duties, from manual labor to producing a male heir. According to the Worldwide Fistula Fund, a charitable organization based in St. Louis, Missouri, "These women become social outcasts, isolated from family, friends, village society, and religious life."

In the poorest countries, women and girls often have no say concerning when and whom they marry. Many contract VVF as adolescent brides, their immature bodies unable to handle the demands of childbirth.

In industrialized countries, 1 in 4,100 women die in childbirth. According to UNICEF studies, sub-Saharan Africa's maternal ...