Women

Women Will Be Hit Hardest By Climate Change

Alanna Shaikh November 20, 2009 - 12:49 pm

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The poorest billion people on the planet contribute only 3% of the global carbon footprint. Those same billion people will also bear the brunt of climate change. Those people tend to be farmers, and they tend to be women.

 

The UN Population Fund has issued a new state of the world’s population report about the impact of global climate change on women, stating that “Drought and erratic rainfall force women to work harder to secure food, water and energy for their homes…Girls drop out of school to help their mothers with these tasks. This cycle of deprivation, poverty and inequality undermines the social capital needed to deal effectively with climate change.” 

In response to the stunning inequality of the impact of climate change, UNFPA calls for measures to improves the lives of women and mitigate the impact of climate change. That includes supporting education for women and girls, expanding access to reproductive health services, and doing better research on gender and population dynamics in climate change. It’s small stuff compared to the magnitude of the problem of climate change. Better, though, than nothing.

 

 

Progress - and Gaps - in Women's Health

Alanna Shaikh November 13, 2009 - 12:44 am

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The United Nations Population Fund organized a high-level meeting in Istanbul this week, calling attention to the economic benefit of supporting family planning and the rights of women. The meeting focused on the challenges that face Central Asia and Eastern Europe as the countries in the regions try to meet the Millennium Development goals that relate to maternal mortality. The meeting issued a progress report that discussed the challenges facing Eastern Europe and Central Asia and the progress that has been made so far. Here’s the good news:

  • Maternal mortality has fallen by half, from 51 per 100,000 live births to 24
  • Fifteen years ago, more pregnancies resulted in abortions than live births; the ratio has now decreased to 494 abortions to 1000 births
  • Antenatal coverage and skilled birth assistance is widespread

They also signed a statement reaffirming their commitment to improving women’s health. It was pretty much the usual stuff – access to reproductive health care, reducing maternal mortality, investing in women’s health and education.  These are all important and valuable, but not especially surprising.

A few of the provisions did surprise me. The statement recognized the importance of the private sector, but also recommended that “that ongoing health reforms focused on decentralization and privatization should safeguard access for the poor to quality sexual and reproductive health services including maternal care, family planning, and reproductive health commodities. They also “recognize the existing inequities in access and quality of reproductive health services.” This focus on making sure that health sector reform promotes equity struck me as both unexpected and a very good thing.  

 

AIDS is the leading cause of death and disease among young women

Vanessa Valenti November 10, 2009 - 11:00 am

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I don't know what's more sad - to actually hear about this news, or that I wasn't too surprised to hear it. In its first-ever study done on women's global health, the World Health Organization (WHO) found that the AIDS virus is the leading cause of death and disease among women aged 15 to 44. Unsafe sex is the leading risk factor in developing nations:

Unsafe sex is the leading risk factor in developing countries for these women of childbearing age, with others including lack of access to contraceptives and iron deficiency, the WHO said.

Throughout the world, one in five deaths among women in this age group is linked to unsafe sex, according to the U.N. agency."Women who do not know how to protect themselves from such infections, or who are unable to do so, face increased risks of death or illness," WHO said in a 91-page report. "So do those who cannot protect themselves from unwanted pregnancy or control their fertility because of lack of access to contraception."

The data were included in a report that attempts to highlight the unequal health treatment a female faces from childbirth through infancy and adolescence into maturity and old age.

Another interesting thing to note from the study is that while young women are the ones being overwhelmingly being inflicted with the disease, women are also the ones who primarily provide care for HIV/AIDS-related illnesses. This fact sends a powerful message about the state of AIDS in the world, particularly countries with high rates  - that women are largely alone in this struggle, and in such a significant way. But while their lives are so deeply ingrained in the reality of the AIDS epidemic - contracting the virus and responsible for caring those inflicted - their lack of control over their own prevention is what's striking.

Lastly, while there are reproductive health organizations and services in many countries who are working to educate women about HIV prevention and improve the general status of women (as systematic discrimination and violence against women are a major cause behind these high rates), married women are generally targeted in their outreach while single women, adolescents, sex workers, and ethnic minorities are left at the wayside. So not only is education and agency needed for these women to make informed decisions about their health and lives, but organizations need to ensure those efforts are inclusive to all women.

Check out WHO's press release for more info.

 

 

 

In developing countries, breast cancer strikes women a decade earlier

Vanessa Valenti November 3, 2009 - 2:46 pm

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As Breast Cancer Awareness Month ended in the U.S. last week, new information reminds us that focus shouldn't be delegated to just one nation, let alone to just one month. AP had a story yesterday not only on the rise of breast cancer in poverty-striken nations, but on how women are developing the disease at a much younger age than in the developed world. Additionally (and not surprisingly), diagnosis is often made late in the game:

 

International cancer specialists meet this week to plan an assault on a troubling increase of breast cancer in developing countries, where nearly two-thirds of women aren't diagnosed until it has spread through their bodies.

Adding to the problem, some worrisome data suggests that breast cancer seems to strike women, on average, about 10 years younger in poor countries than it does in the U.S. No one knows why.

"Today in most developing countries you see a huge bulge of young, premenopausal women with breast cancer," says Knaul, who heads Harvard's Global Equity Initiative and was herself diagnosed at age 41 while living in Mexico.

 

New Harvard research is estimating that developing counties will account for 55 percent of the world's 450,000 expected breast cancer deaths this year. Fortunately, there are some initiatives in place like the Global Equity Initiative and the Breast Health Global Initiative working towards increasing access to care and early diagnosis in various countries worldwide, but it's apparent that things aren't getting better. There just simply isn't enough being done.

 

India Can Provide Excellent Maternal Care – But Not to Everyone

Alanna Shaikh October 30, 2009 - 2:16 am

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A new article at The Daily Beast highlights the risks of motherhood in India in a striking way. Every year, half a million women die as a result of pregnancy. And for every death, there are 20-30 cases of maternal injury. At the same time, high-end private clinics support surrogate mothers bearing children for infertile couple from the wealthy world. It’s an ugly dichotomy, and it points to financial inequalities and health sector weakness.

 

Human Rights Watch has a new feature on maternal mortality in India, and they found that most maternal deaths come from bad referrals. Women in life-threatening emergencies were being referred to health facilities that either would not accept them or couldn’t provide the care they needed. (Women at private surrogacy clinics, of course, are already at a facility that can handle obstetric emergencies.)

Overcoming this problem this would require a two-prong solution. Better referral systems, to make sure women are going somewhere that can care for them, and more facilities equipped to take emergency referrals. Both of those things are tough to achieve.

 

 

Unsafe abortions kill 70,000 women a year

Alanna Shaikh October 14, 2009 - 12:57 pm

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The Alan Guttmacher Institute has issued a new report on global abortion rates. They found that while the total number of abortions globally fell from 45.5 million in 1995 to 41.6 million in 2003, 20 million unsafe abortions still occur every year. That’s a huge number. These 20 million unsafe abortions kill 70,000 women each year and seriously harm millions more.

Those were not the only surprising numbers in the report. It also found that abortion rates are unaffected by the legal status of abortion. The report reads, “abortion occurs at roughly equal rates in regions where it is broadly legal and in regions where it is highly restricted. The key difference is safety—illegal, clandestine abortions cause significant harm to women, especially in developing countries.” Restrictive abortion laws seem to be forcing women into dangerous abortions, not preventing abortions. In fact, from 1995 to 2003, abortion laws grew less restrictive, even as abortion rates fell.

What did prevent abortions was increased contraceptive use. The past decade has seen an increase in contraceptive use, a decrease in unintended pregnancies, and a decrease in abortions. The worldwide unintended pregnancy rate declined from 69 per 1000 in 1995 to 55 per 1000 in 2008. The proportion of married women using contraception increased from 54% in 1990 to 63% in 2003. It’s a correlation, not a definite causality, but I don't think it’s a big jump to argue that increased contraceptive use led to decreased unintended pregnancies.

It seems clear to me that we know what to do to reduce the overall abortion rate and the terrible death toll of unsafe abortion: make contraction available to couples who want it.

 

One in Ten Births is Premature

Alanna Shaikh October 5, 2009 - 7:07 am

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A new study by the World Health Organization and the March of Dimes found that one in ten births, globally, is premature. “Around the world, about one in 10 babies are born prematurely each year, and more than one-quarter of the deaths that occur in the month after birth are the consequence of preterm birth.” The data surprised many people; premature birth is often seen as a problem of the wealthy world, and associated with fertility treatments, multiple births, and older mothers. The study, however, found that the highest rate of pre-term birth is actually in Africa, possibly as a complication of maternal malaria infection.

Prematurity is a difficult condition to prevent; it is caused by a wide range of different factors, including malnutrition, poor prenatal care, and anemia. There are very few interventions that have been found to successfully reduce pre-term birth rates. Those that do generally focus on helping mothers who’ve already had one premature child access medical care and family planning. Another report, due out in 2010, is planned to discuss strategies for reducing premature births globally.

 

 

Mothers of Ethiopia III: Pregnancy Complications

Mark Leon Goldberg October 2, 2009 - 12:51 pm

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Hanna Ingber Win is Huffington Post's World Editor. She was recently invited by the UN Population Fund to visit its maternal health programs in Ethiopia, which has one of the world's worst health care systems. In the U.S., a woman has a 1 in 4,800 chance of dying from complications due to pregnancy or childbirth in her lifetime. In Ethiopia, a woman has a 1 in 27 chance of dying. 

This is the third installment of a five-part series on what she learned on her trip. Go to the original post for powerful photographs from the trip.  Part 1.  Part 2.

MEKELLE, Ethiopia -- Dima Yehea's two-year-old son has large brown eyes and a sweet, carefree smile. He sits on his mother's lap wearing only an old T-shirt. Dima, dressed in a loose hospital gown, looks at me with intent, studious eyes. Her baby turns towards her, grabs her left breast with both hands and nurses for a few minutes. As the baby focuses on his meal, Dima concentrates on me, a Westerner in Ethiopia.

Dima also wears a big smile on her face. Her hair has recently been styled, pulled back in tight braids, in preparation for her departure from the hospital and trip home to her rural village.

A young woman living in a country with one of the world's worst health care systems, Dima has experienced needless, preventable pain and tragedy. Yet she appears happy to share her story. To an American, it is a story of the poor state of women's health care in Ethiopia. To Dima, it is a story of triumph and hope. <!--break-->Dima was 15 when her family prepared a wedding ceremony and married her off to a man she had never before met. Soon after getting married, her husband forced himself on her.

"Did you understand what he was doing?" I ask her.

Dima's smile slips away. She slowly shakes her head. "I was a kid," she says through a translator. "I didn't know what was happening."

The sex was painful, but her husband did not stop.

Dima soon became pregnant with her first child. She was living in a rural village called Late about 145 kilometers from Mekelle, the largest city in northern Ethiopia.

Like 94 percent of Ethiopian women, Dima went into labor at home without access to a skilled birthing attendant. Too young and undeveloped to be giving birth, Dima's body could not handle the labor. The baby's head pushed down on her pelvic bone, not yet wide enough to let the baby pass naturally, for 48 hours.

Dima eventually gave birth, but the baby had died during the protracted labor. Plus, the prolonged pressure caused the tissue between her bladder and vagina to die. A hole called an obstetric fistula formed.

Obstetric fistulas are practically unheard of in developed countries because women give birth at a later age and therefore have more developed bodies - plus, even more importantly, they have access to medical care. If a woman has a complication during pregnancy, like about 15 percent of women do, she can have a Cesarean section.

Dima had no such luck.

In Ethiopia, where such surgery is rarely an option in the rural areas where women like Dima live, obstetric fistulas plague about 100,000 women, says Karen Beattie, the project director for Fistula Care, a project managed by EngenderHealth and funded by USAID. The exact number of women living with fistulas -- like the exact maternal mortality rate -- remains unknown due to lack of good population-based statistics, she says.

About 2 million women in the developing world currently live with untreated fistulas, according to the UN Population Fund.

"The whole problem lies in detection of difficult labor and appropriate referral to emergency obstetric care," says Dr. Melaku Abriha, an obstetrician and gynecologist who runs the Mekelle branch of the Hamlin Fistula Hospital.

The hospital's facility in Addis Ababa opened in 1974 and has treated more than 32,000 women, according to public relations officer Feven Haddis. The Mekelle branch opened in February 2006 and has operated on around 600 women from rural villages surrounding Mekelle. Ninety-one percent of the surgeries have been successful, Dr. Melaku says.

Dima's fistula caused her to leak urine at all times. The uncontrollable discharge left her uncomfortable and smelly.

Still just a teenager, Dima became so embarrassed of herself that she stopped seeing her friends.

"I felt like they were talking about me behind my back," she tells me.

Dima told her husband that she did not want to have sex with him. She felt unhealthy and uncomfortable. But he insisted. After having a second child, the little boy now sitting on her lap, Dima began refusing to have sex. Her husband divorced her and married another woman. Dima moved back home with her parents.

Her baby stops nursing and turns to watch me. Dima's bare breast rests on top of her gown. She explains that she stayed at her parents' house, without any contact with the outside world, until a local non-governmental organization visited her village and found her. The group, Relief Society of Tigray, helps women who have developed fistulas. They brought Dima to the hospital in July, and Dr. Melaku performed surgery on her to repair the hole between her uterus and bladder. The surgery cost about US$400 and was paid for by the hospital.

The surgery was successful, and Dima will return to her village the day after I meet with her.

I ask Dima how she feels now, and the joy returns to her face. Her eyes open wide, and she starts talking fast and loud. "I am happy!" she says, pounding her chest with her clenched fist. "I will start to talk with the neighbors and community. I will look for a new job, and I will start a new life."

She says that she cannot return to farming because after living with a fistula for six years and undergoing surgery, she does not think her body will be strong enough for the intensive work. In general, women who undergo fistula surgery can return to farming once they have fully healed, says Karen Beattie of Fistula Care.

Dima also no longer has a husband to help her with the farming. Instead, she says, letting out a laugh, she will become a businesswoman.

"My plan is now to change my life," she says. "I will do business and earn some money for me and my baby."

It is unlikely that the number of fistula cases in Ethiopia is decreasing. However, more places like the Hamlin Fistula Hospital are opening and serving more women, says Beattie. Furthermore, increased attention by the international aid community over the past 10 years on the issue of fistulas has led to greater awareness about the problem of both this medical condition and women's maternal health in general.

Despite the gains, only about a third of the 9,000 fistula cases that occur in Ethiopia each year get treated, according to the UN Population Fund.

"Fistula is a marker for what is happening for maternal health more generally," Beattie says. "It has shined a light on the need for more access to emergency obstetric care."

Tomorrow: Visiting a rural health post in Ethiopia

 

Mothers of Ethiopia II: Escaping Child Marriage

Mark Leon Goldberg October 1, 2009 - 10:51 am

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Hanna Ingber Win is Huffington Post's World Editor. She was recently invited by the UN Population Fund to visit its maternal health programs in Ethiopia, which has one of the world's worst health care systems. In the U.S., a woman has a 1 in 4,800 chance of dying from complications due to pregnancy or childbirth in her lifetime. In Ethiopia, a woman has a 1 in 27 chance of dying. 

 This is the second installment of a five-part series on what she learned on her trip. Go to the original post for powerful photographs from the trip.  Part 1.

The first time Tadu Gelana's mother suggested she get married, Tadu thought she was kidding. Only 14 years old, Tadu had not yet finished school or had her first menstruation cycle. Tadu laughed at the suggestion. The second time her mother mentioned it, Tadu told her she wasn't interested.

Her mother did not relent.

Tadu's brother, who was about twice her age and had taken care of her for many years, had recently passed away. Tadu felt she should be grieving for the loss of her big brother, not preparing for a joyous wedding ceremony.

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My beloved brother died at that time, and I had that sorrow in me," she says, wiping away tears. "I was very much against [getting married]. I wanted to continue my education with my friends." Tadu, wearing a grey hooded sweatshirt and black T-shirt, looks like a typical teenager. Her braided hair is pulled back into a bun and small shiny earrings add a sparkle to her face. She tells me her story as we sit in Biruh Tesfa ("Bright Future"), an informal school for runaway girls in Ethiopia's capital, Addis Ababa. The school receives funding from the UN Population Fund (UNFPA), which has sponsored my trip, is operated by the Ethiopian government and gets technical support from an international non-governmental organization called Population Council. Tadu never formally met the man whom she was assigned to marry but she saw him in her small town in central Ethiopia. He was tall with brown skin. She does not know how old he was - only that he was "an adult." "When I was alone, I was afraid of him," she says. "When I was with other girls, they protected me. We all laughed at him." Tadu solicited her uncle to try to convince her mother to let her stay in school and not get married. Her mother agreed. But after Tadu's uncle left, her mother again demanded that Tadu get married. "My mother told me, 'Either you have to marry, or you leave this house,' " she says, as she stares down at the school's metal desk. Tadu decided to leave her mother, friends and school and move from Ambo to Addis with her aunt and uncle. Her aunt found her a job as a domestic worker with her neighbor. Tadu, now 16, lives with her employer and spends her days cleaning the house, washing clothes and dishes and cooking for the family. I ask Tadu about her friends in Addis and what they do for fun. I try to get her to smile and laugh like other girls her age, but she does not. She maintains a solemn look, staring down at her hands or the desk, quietly answering my questions. For a few hours every day, the family allows Tadu to go to Biruh Tesfa, where we meet one morning in late August. Two centers in Addis serve about 600 girls between the ages of 10 and 19, says Habtamu Demele, the project coordinator of the center. Most of them have escaped early marriage. Even though the legal age to marry in Ethiopia is 18, more than 30 percent of girls living in rural parts of the country are married by age 15, according to the Population Council. In Amhara region, where most of the girls at the center come from, almost half of the girls have married by age 15 and close to two-thirds by age 18. Ethiopia ranks among the top 10 countries for child marriage, according to the International Center for Research on Women's analysis of the country's Demographic and Health Survey data. Families marry their daughters early due to cultural beliefs and practices related to attempting to keep a girl's chastity, ensuring a young bride's obedience and subservience, maximizing childbearing years and enhancing a family's status, according to UNFPA. Early marriage can cause higher rates of maternal and infant mortality, vulnerability to HIV/AIDS, abuse, isolation and long-term psychological trauma from forced sex, according to UNFPA. Girls aged 15 to 20 are twice as likely to die during childbirth as women in their 20s and girls under the age of 15 are five times more likely to die of maternal causes, according to UNFPA. This is because girls' bodies are often too young and undeveloped to endure child birth. When a girl gives birth before her body is fully developed, she often has difficulty during labor and a higher chance of developing a maternal complication such as hemorrhaging or obstetric fistula. (See tomorrow's installment of this series on battling obstetric fistulas in Ethiopia.) A 2005 UN Children's Fund (UNICEF) report on child marriage also found that girls who marry young have a much higher chance of being victims of domestic violence. The majority of the girls at the Biruh Tesfa center fled their rural villages, took a bus to Addis and got off at a bustling, chaotic station close to the program site. They arrived in Addis alone without access to services or support, says Habtamu. "These girls are the invisibles. No program is covering them," he says. So-called brokers found the girls at the bus station and got them jobs as domestic workers for low-income Ethiopian families in Addis. They often work under demeaning and difficult conditions, with no time to go to school or make friends. The Biruh Tesfa project employs mentors, young women who come from the community, to go to the homes where the girls work and convince their employers to let them participate in the program. Aynalem Kibebew, 25, lives in a tiny house made of corrugated metal across the street from the center and serves as a mentor for about 30 of the girls. Since the employers often do not allow the girls to attend school, the mentors like Kibebew provide them with informal education for an hour or two every day at the center. They also teach the girls life skills like reproductive health, HIV education and hygiene. Once the girls finish the program, they are eligible to enter formal school in the fourth grade, Habtamu says. Another girl at the center, Kelemua Wondimu, says she fled her village in Amhara region to Addis when she was 17 because she too did not want to get married. She had seen what happened to her older sister and did not want that life for herself. When her sister turned 15, Kelemua says, her parents prepared a wedding ceremony and made her marry a man she had never met. She then had a baby within a year. "I saw that and decided not to marry at that age," Kelemua says, clutching her notebook as she sits at a desk in one of the center's classrooms. Charts teaching numbers and punctuation marks cover the walls. "Instead, it is better to continue my education and learn more." Tomorrow: Battling pregnancy complications in Ethiopia Read more at: http://www.huffingtonpost.com/hanna-ingber-win/mothers-of-ethiopia-part_...

 

Mothers of Ethiopia Part I: Zemzem's Journey

Mark Leon Goldberg September 30, 2009 - 3:26 pm

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Hanna Ingber Win is Huffington Post's World Editor. She was recently invited by the UN Population Fund to visit its maternal health programs in Ethiopia, which has one of the world's worst health care systems. In the U.S., a woman has a 1 in 4,800 chance of dying from complications due to pregnancy or childbirth in her lifetime. In Ethiopia, a woman has a 1 in 27 chance of dying. 

 This is the first in a five-part series on what she learned on her trip. Go to the original post for powerful photographs from the trip. 

JIMMA, Ethiopia -- When Zemzem Moustafa went into labor with her fifth child - at age 30 - she could sense a problem. Living in a thatched-roof hut in Ilebabo, a rural village in western Ethiopia, she and her husband walked to the local health post. A health extension worker there could tell that the baby was in the wrong position, but the worker could not help Zemzem and referred her to the hospital. And so Zemzem's journey began, one that ends in tragedy for thousands of women in Ethiopia each year.

She and her husband, a poor farmer, collected 50 birr (US$4) from their neighbors for the trip to a hospital in Jimma, the closest big town. Leaving at around 4 p.m. on a Friday afternoon, they walked through the fields for an hour until they arrived at a road. Standing at the side of the road, they hailed a rickety old minibus packed with other villagers.

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August is the rainy season in western Ethiopia and the minibus got stuck in the mud. Zemzem, whose contractions became more and more intense, spent the night on the side of the road with her husband and the other passengers. The next morning the men freed the minibus from the mud and the trip continued.

Zemzem and her husband reached Jimma at noon on Saturday, a full 20 hours after the trip began. They drove down the dirt road that runs through the center of the town, past the young boys herding sheep, the donkeys with bushels of hay strapped to their backs and the women sitting on the side of the road selling vegetables.

By the time Zemzem arrived at Jimma Referral Hospital, her uterus had partially ruptured as a result of the prolonged labor. A gyno/obs resident and a health officer operated on her immediately, and they successfully saved the lives of Zemzem and her baby.

"If she [had been delayed] two or three hours more, the baby - and even the mother - would have lost her life," Dr. Chuchu Girma, a surgeon and the clinical director of the hospital, tells me as we chat with Zemzem in the maternity ward.

Maternal health specialists say that there are three ways in which necessary treatment is delayed: when the mother or family first decides to seek appropriate medical care for an obstetric emergency, as the family tries to take the woman to a hospital and faces transportation impediments and once the woman reaches the health institution and faces setbacks in being admitted and getting medical attention.

I am visiting the Jimma Referral Hospital as part of a trip sponsored by the UN Population Fund (UNFPA), which provides support for the government's program to train non-physician clinicians to perform procedures, such as obstetric surgery, traditionally performed by doctors. The health officer who operated on Zemzem is being trained to become one of these non-physician clinicians.

Zemzem is lying on an old metal bed with the paint chipping off, under a heavy blanket that looks itchy and dirty. A used surgeon's glove is tied to the bedpost. The sheet has fallen down, exposing a thin plastic mattress.

When I enter the maternity ward at Jimma Hospital, the stench practically smacks me in the face. The smell, a combination of urine and feces and other bodily fluids, overpowers all my other senses.

Each room along the maternity ward has a sign posted above the door in English and Oromiffa, the local language: "Labor Room", "High Risk Room", "Delivery Room". Zemzem stays in "Septic Room." The Septic Room houses women who have had pregnancy complications like ruptured uteri and fistulas that involve extra discharge.

When Dr. Chuchu and I enter the Septic Room, Zemzem is lying flat on the bed with her baby under the blanket. I ask about the baby, and Zemzem's face lights up. She pulls the blanket back to reveal her newborn. I ask if the baby is a girl or a boy, and Zemzem, saying he is a boy, smiles and laughs.

"They are very happy when they get men," Dr. Chuchu says to me.

Zemzem has remained at the hospital for three weeks because she has an infection. Dr. Chuchu lifts up Zemzem's gown to reveal a large white bandage from the surgery.

Her husband has returned to her village to take care of the other four children, a medical intern says, translating Zemzem's answers in Oromiffa, the local language, into the national language, Amharic, for Dr. Chuchu, who translates into English for me.

Some girls in Ethiopia get married as young as 10 or 11, Dr. Chuchu says, and they then get pregnant before their bodies fully develop. This increases the likelihood that they will have obstructed labor. A ruptured uterus is a very simple, manageable problem, he says. But the girls or young women, living in rural villages, usually give birth at home and lack access to a health professional during delivery -- like 94 percent of Ethiopian mothers.

Without help during delivery and without surgery and a blood transfusion if the mother's uterus ruptures, the girl or woman often dies. In the United States, eight women die during childbirth for every 100,000 live births, according to the UN Children's Fund (UNICEF). In Ethiopia, 673 women die, making the maternal mortality rate 84 times higher. UNFPA considers every single maternal death preventable.

Zemzem's other children range in age from 2 to 12, the intern translates as he gently pulls down her gown to cover up her back.

I bring out my camera, and Zemzem smiles glowingly at her new son.

No one else in the "Septic Room" can empathize with Zemzem's joy. The other three patients all had fully ruptured uteri and lost their babies.

Dr. Chuchu and I stand next the bed of another patient. The blanket engulfs her tiny body, so small it looks like it belongs to a child. An intravenous drip stands next to the bed, pumping antibiotics into the young woman. Dr. Chuchu looks at her chart -- she has lost almost two-thirds of her blood during her operation and now waits for a blood transfusion. He pulls down one of her lower eyelids. The entire eye is white, not a trace of red veins.

"This is a case [where the mother] usually dies," Dr. Chuchu says. If she had been at a rural health post or health center, she would not have had access to a surgeon or to equipment necessary for a blood transfusion.

The woman looks so vulnerable that I whisper in Dr. Chuchu's ear, asking if he thinks she will make it. Yes, she will survive, he says. She will get blood here.

Dr. Chuchu asks the patient where she comes from, but she is too weak to answer. He looks at her chart. She comes from Gatera, 112 kilometers from Jimma. She is 22 years old and has been pregnant four times. This is the third child she has lost. When she arrived at the hospital, her uterus had already ruptured. She therefore lost the baby and had to have her uterus removed.

If she is Muslim, her husband will take another wife to have more children, Dr. Chuchu tells me. He checks her chart. "Oh, she's Muslim," he says. "He will definitely have another wife."

 

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