“Obstetric fistula is the most dramatic aftermath of neglected childbirth.” – World Health Organization (WHO)

I propose to use the Alexia Foundation Grant to continue my coverage of the plight of the estimated 100,000 women in Ethiopia suffering from obstetric fistula, and the impact of this troubling health condition on that country’s local communities.

During a week in the summer of 2007, I photographed the surgical and counseling work being done at Addis Ababa Fistula Hospital, and its branch facilities throughout Ethiopia, in an effort to capture the internal and psychological injuries many women sustained while giving birth. On my journey back to the U.S., I told myself, “I want to come back again and finish what I started.” It is now time to expand my work on the obstetric fistula problem in Ethiopia, and to take a closer look at the lives of these women and their communities.

I met 15-year-old Alganesh as she arrived at the Addis Ababa Fistula Hospital in Addis Ababa, Ethiopia. The young girl became pregnant at the age of 14 and she was in labor for 4 days without any medical help. Her baby died. Her husband left her. Alone, suffering from fistula, she was unable to take care of herself. She came to seek professional help at Addis Ababa Fistula Hospital.

Sadly, Ethiopia has one of the highest maternal death rates in the world. By the age of 8, girls in rural Ethiopia carry most of the water and wood for their families. The combination of strenuous work and poor nutrition causes a metabolic imbalance and a stunting of their growth. The girls enter young adulthood with tiny, bony pelvises, and many marry soon after their 9th birthday in arranged marriages. Consequently, 15% of the approximately 29 million women living in rural, mountainous areas of Ethiopia experience serious complications during childbirth. For a woman in obstructed labor, the nearest doctor able to perform a cesarean section may be over 200 miles away. In Ethiopia alone, about 9,000 women develop fistula each year.

An obstetric fistula is a hole between the vagina and adjoining organs, and is caused by unrelieved, prolonged or obstructed labor, often lasting from 1 to 7 days. The constant pressure of the baby's bony head against the mother's bony pelvis damages her internal tissues. Fistula creates an unyielding inconvenience not only for the woman living with this condition, but also for her family and her entire community. Because of the wetness and odor caused by their constantly leaking urine, these women are often shunned from their home villages, and are ignored or abandoned with no support and no means for survival. Many of them go to monasteries to live, while others choose the anonymity of homelessness in a big city.

The Alexia Foundation Grant will enable me to develop a more in-depth examination of obstetric fistula through photographs, audio interviews and first-hand narratives from those who suffer from or have been affected by this adverse but preventable health condition. I have been involved with the Fistula Foundation and will collaborate with them to locate more fistula victims in the various areas of Ethiopia. For the cost of a plane ticket, I will be able to continue my coverage of the plight of the estimated 100,000 women in Ethiopia suffering from obstetric fistula.