The Harper government’s recent and rather surprising interest in the health of women around the world through their maternal health initiative created a storm of controversy when it was revealed that the Harper government excluded access to safe abortions for women in developing nations.
Having lived in Africa, it became apparent to me very quickly that those of us that live in the developed world should not try to force our values on people of other nations. We have our culture and they have theirs. We have our values and they have theirs. While we may regard our culture and values as superior to theirs, that is far from the truth. We should not judge their activities through our Western-based filters or view their cultures through our Western lenses.
Recently, I have become aware of a particular cultural issue that is part of life for girls and women living in Niger. Niger has the highest rate of child marriage in the world according to the United Nations. The minimum legal age for marriage in Niger is 15, however, girls are frequently married by the age of 12 with four out of five girls married before the age of 18. Only one in two girls in Niger enrol in primary school with only one in five continuing on to secondary school. By adulthood, only 18 percent of women in Niger are literate.
According to IRIN (Integrated Regional Information Networks the humanitarian news and analysis service of the United Nations Office for the Co-ordination of Humanitarian Affairs), Niger is one of the most dangerous places in the world for girls and women giving birth. As I noted above, girls are often married between the ages of 12 and 14 and often become pregnant in their early teens before their bodies reach the stage that they are physically able to safely give birth. The mortality rate of infants during birth by very young mothers is very high; as a result of poor or non-existent emergency obstetrical care and inadequately equipped rural hospitals, many young girls have their dead foetuses cut from their bodies after prolonged and unsuccessful labour in what is known as obstructed labour. As a result of reduced blood supply during obstructed birth labour, the tissues between the vagina and bladder or rectum or both are weakened and frequently tear. The end result is a hole known as an obstetric fistula; through the fistula, urine and faeces can pass uncontrollably and continuously. Medical care is generally not sophisticated enough in these rural areas and, as a result, obstetric fistulas that develop after birth are often not repaired. The women that suffer from fistulas often smell; as a consequence, they are often divorced by their husbands and ostracized from their communities.
Fistulas can also develop as a result of giving birth to large numbers of children where the pregnancies have been very closely spaced. Many women in Niger have given birth to more than 12 children; the national average is 7.1 births per woman. After giving birth to so many children, fistulas can develop as the tissues around the vagina, bladder and rectum simply collapse.
According to IRIN, there are just four doctors in Niger that are capable of repairing a fistula; the cost is estimated at $2100 US, far beyond the means of just about every woman in Niger where the average per capita annual income is estimated at $700. As well, according to the World Health Organization, there are two million girls and women living with fistulas and an additional 100,000 cases are added every year.
One solution to the issue of early pregnancies would be to let girls finish school prior to marriage since most of the fistulas develop in very young girls. By the age of 16, most girls are physically capable of delivering a healthy baby and retaining their own health. This would reduce the number of fistula patients. Providing these girls and women with control over when they first become pregnant and how many children they have would also have an impact on the number of patients. As well, funds from developed nations could be used to upgrade obstetric and gynecologic facilities, especially in rural areas where primitive clinics are often the only available option for care.
So Mr. Harper, I ask you, which is worse, providing abortions for girls that are far too young to safely give birth and allowing abortions in a society where the health of women who give birth to great numbers of children are at risk or taking a stand against abortion solely based on the beliefs of special interest groups that number among supporters? I’m not saying that abortion is the best or only solution for obstetric fistulas and accompanying reproductive health but, even if it’s of some assistance in a few cases, it is an option that should be left to the discretion of the local physicians who understand their patients’ needs. African culture is a culture that those of us who live in the Western world simply don’t understand and will likely never be able to change. We have to adapt aid programs to meet their needs not the other way around.
Mr. Harper, please don’t impose your morality and the morality of your wealthy supporters on the women of the developing world who so badly need our unconditional help. The ball is in your court, all you have to do is what is right for the girls and women of Africa. The upcoming G8 and G20 summits give you an opportunity to present a balanced case for safe and effective abortion in developing nations on the world stage.
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