Putting a new focus on maternal health and obstetric fistula in particular, which devastates the lives of women and girls in many poor countries, the United Nations Population Fund (UNFPA), has given its 2014 UN Population Award to an Italian doctor working in Mozambique and to an American maternal and child health organization with programs in scores of countries worldwide.
Aldo Marchesini, the doctor and a Roman Catholic priest, as well as Jhpiego (formerly the John Hopkins Program for International Education in Gynecology and Obstetrics) have both been a presence in Africa since the mid-1970s. Marchesini, who first encountered fistula in Uganda in 1974, eventually settled in Mozambique, staying through a brutal and destructive civil war to treat women even as he became the target of combatants.
Jhpiego, the program that began at Johns Hopkins medical center in 1974, was created to reduce maternal deaths generally and to promote family planning as a way of ensuring safer pregnancies through spaced births, prenatal attention and improved facilities with qualified health workers for women giving birth at home or in a clinic. The program, which started its work in Kenya, prides itself on devising and using low-cost innovations that can be widely implemented.
Both Marchesini and Jhpeigo train local doctors and other medical staff in various specialties of maternal health. The reduction in maternal mortality is failing by a wide margin to meet its 2015 Millennium Development Goal. In Mozambique, UNFPA supports Marchesini’s work.
Obstetric fistula, a result of prolonged or obstructed labor when there is no professional expertise available to induce a safe birth, tears or punctures a woman’s birth canal, which leads to lifelong incontinence and social ostracism. Among the most tragic cases are those of girls often too young for a normal, relatively easy childbirth — whose lives are ruined to one extent or another by fistula. Pregnancy-related deaths, including from botched abortions, are the leading cause of death and disability among teenage girls in much of the developing world, where maternal and child health care and information are inadequate or nonexistent.
Surgical procedures to repair fistula are often out of reach for most women and girls who suffer from this debilitating injury or they may not even be aware of the treatment. Marchesini, who told the UN Population Fund that he has probably performed 1,000 such operations, also said he often traveled miles to patients who could not come to him.
The emphasis on obstetric fistula in the award to Marchesini is part of a burgeoning if still small trend in medicine toward tackling other kinds of bodily damage done to girls and women, partly because the data on global maternal mortality are so worrying. A few experiments are in the works to try to find a way to reverse the genital destruction in at least some girls and young women who have undergone female genital mutilation, and projects for improving the work of midwives worldwide are numerous.