Recenty a forklift removed a statue of 19th century surgeon J. Marion Sims from New York City’s Central Park, relocating it to a cemetery in Brooklyn where Sims is buried. He is controversial. For some, Sims is the “father of modern gynecology” – he developed the speculum, a device used in pelvic exams today, and pioneered surgical treatment for obstetric fistula, a devastating childbirth injury which renders a woman incontinent of urine, feces or both. For others, Sims is a symbol of brutal unethical medical oppression. This is because he perfected his surgical techniques to treat fistula on three enslaved women, Lucy, Anarcha, and Betsey, who each developed fistula from prolonged, unrelieved obstructed labor.
As slaves, Lucy, Anarcha, and Betsey had no legal rights and clearly did not have the freedom to provide truly informed consent, though historical records show that Sims secured what he considered to be consent. Thus, the decision to remove Sims’ statue from a place of prominence is understandable. But, for more than a century Sims’ surgical techniques have helped transform the lives of women with obstetric fistula, arguably the most agonizing and socially stigmatizing injury there is.
The continuing tragedy and injustice is twofold. First, for hundreds of millions of women of color in Asia and Africa similar conditions that led to Lucy, Anarcha, and Betsey being grievously injured in childbirth over 170 years ago still exist today, namely lack of obstetric care. Second, though obstetric fistula was largely eradicated a century ago in developed countries like the United States, at least a million women of color still suffer unnecessarily for want of surgery that can cure them.
While most westerners have never encountered obstetric fistula, the same is not true for our grandmothers and great-grandmothers who likely delivered their children at home. In their communities would-be mothers dying or being injured in childbirth was common. Indeed, there used to be a hospital devoted to treating women with fistula not far from Central Park, where the Walforf Astoria Hotel stands today. It closed in the 1890s.
What has dramatically cut the rates of maternal death and largely eradicated fistula in the United States and other developed countries is the availability of hospital-based deliveries, emergency obstetric care and the widespread use of C-sections to relieve obstructed labor. Yet, for many women in Africa and Asia, giving birth at home without access to emergency obstetric care when help is needed is the norm, and death and injury are consequently vastly more frequent. For comparison, data from the World Bank indicate the lifetime risk to an American woman from maternal death is 1 in 3,800. For a woman in Africa’s most populous country, Nigeria, the rate is 1 in 22. But deaths represent a fraction of the problem: for every would-be mother who dies, the UNFPA estimates at least 20 to 30 are injured.
May 23rd is the fifth annual International Day to End Obstetric Fistula, created by the United Nations to raise awareness of and intensify actions toward ending obstetric fistula. It is part of the Campaign to End Obstetric Fistula which marshals the strength of activists, doctors, governments, the private sector and NGOs across continents to confront this ancient scourge. Because women with obstetric fistula are too often politically, economically, and socially marginalized, the UN recognized that outside groups are critical to mobilizing support for funding surgeries, training surgeons and conducting outreach efforts to help ensure injured women are able to access and afford surgery.
There are at least a million women unable to lead full, healthy and productive lives at a great cost to them, their families and their communities, because of an injury that is both preventable and treatable. While progress is dogged, the concerted efforts of dedicated people around the globe can help end obstetric fistula in a generation, so that no woman will be forced to lead a life of misery simply for trying to bring a child into the world.
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