Page last updated at 17:20 GMT, Monday, 26 October 2009
Maternal mortality across the world

By Pascale Harter
BBC News, Ethiopia

Hailemariam Workneh plays with his son while his wife is treated for fistula
Hailemariam Workneh saved for five years to get his wife to hospital

As health ministers from around the world meet in the Ethiopian capital to tackle maternal mortality, women suffering birth-related injuries are given a new lease of life through a simple operation.

Hailemariam Workneh is trying to amuse his son outside the Hamlin Fistula Hospital in Addis Ababa.

They have one toy - a small rubber crocodile which two-year-old Awel squeals and runs away from, before edging back towards it and squealing again.

Hailemariam says it's not easy to keep his son distracted while his mother gets treated for fistula. But he is glad to be here. Finally.

It took him five years to save up the money to bring his wife here from their village in the north.

He is the only husband we see at the clinic.

In my town more than 30,000 women have only one women's centre... African governments do not care about their people
Radwan, North Darfur, Sudan

Fifty per cent of women who have fistula are abandoned by their husbands because they leak urine or faeces, or both.

The staff at the Hamlin Hospital are full of admiration for Hailemariam for sticking by his wife.

They keep telling me how unusual it is.

When his wife Zeinat wakes from her surgery she says the same thing.

Needless shame

"I was too ashamed to leave the house because of the smell, I couldn't see my friends," she says. "It was so hard being alone. But my husband is a good man, he didn't neglect me while I was leaking."

Most women, she says, will "cry every day", because they have no-one to help them.

Zeinat and her baby at Hamlin Fistula Hospital, Addis Ababa, October 2009
Zeinat's baby was too big for her to deliver normally

Zeinat's surgery is successful and afterwards, she cannot stop smiling.

"I am excited at participating in life again," she says.

The last five years have involved needless pain and shame.

The causes are in part a lack of resources, in part gender inequality, according to the United Nation's Population Fund.

Like 94% of women in Ethiopia, Zeinat had to give birth without the help of a properly trained health worker.

As is often the case for small-framed Ethiopian women, the baby was too big for her to deliver normally.

Midwife shortage

Prof Gordon Williams, medical director at the Hamlin Hospital, says women in rural areas are often stopped from eating much during their pregnancy, and are worked extra hard in the belief it will stop the baby from growing too big in the womb.

It does not. Instead, by the time she comes to give birth the woman will be weak and malnourished.

A woman talks about living with fistula for years

When she realises there is a complication with the birth it is usually too late.

The nearest health clinic can be more than 100km (62 miles) away - a distance women often walk, while in labour.

But even at the health clinic it is unlikely there will be the equipment to perform a caesarean section, which routinely saves the lives of mother and baby in the West.

It is unlikely there will even be a midwife.

It is said there are more Ethiopian midwives working in Chicago than Addis Ababa.

What is left after the brain drain is one midwife to every 20,000 women of childbearing age.

And they are not in the rural areas, where 85% of Ethiopians live.

Social stigma

So like Zeinat, the woman will have to give birth alone.

And like Zeinat she may lose the baby, and be left suffering with obstetric fistula - a tear between the vagina and the bladder or the rectum, making her continually incontinent.

In the five years since her first child died during labour, Zeinat conceived several times.

Having sex and giving birth again must have been excruciatingly painful.

I hardly considered myself a human being because of the smell
Baysade Shoke, fistula sufferer

Awel is the only one of her children to have survived birth.

But it is the social stigma that the women with fistula talk about.

Baysade Shoke is waiting to be operated on.

She has lived with fistula for 43 years.

"I have lived in darkness," she says.

"I hardly considered myself a human being because of the smell."


She says she is hopeful that the surgery will bring her "out into the light".

When it is over and she feels ready, the hospital will give her money to get back to her village and a new dress to go back in.

A nurse aid at Hamlin Fistula Hospital, Addis Ababa
65% of the staff at Hamlin hospital are long term sufferers of fistula

But Abarash Muskun preferred not to make that journey.

Her surgery was not successful and the stigma of living with the smell of leaking urine is too much so she has stayed on at the hospital, working as a nurse aide.

Abarash is one of the patients the Hamlin Hospital treats each year, but is unable to cure.

What she and the doctors would like to see is prevention; health professionals in well-equipped health centres throughout the country so women do not lose their babies, and do not develop fistula in the process.

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