The Obstetric Vesicovaginal Fistula in the Developing World

vast areas of the world, in South East Asia, in Burma, in India, 'in parts of Central America, South America and Africa 50 million women will bring forth their children this year in sorrow, as in ancient Biblical times, and exposed to grave dangers. In consequence, today as ever in the past, uncounted hundreds of thousands of young mothers annually suffer childbirth injuries; injuries which reduce them to the ultimate state of human wretchedness. Consider these young women. Belonging generally to the age group 15-23 years, and thus at the very beginning of their reproductive lives, they are more to be pitied even than the blind, for the blind can sometimes work and marry. Their desolation descends below that of the lepers, who though scarred, crippled and shunned, may still marry and find useful work to do. The blind, the crippled and the lepers, with lesions obvious to the eye and therefore appealing to the heart, are all remembered and cared for by great charitable bodies, national and international. Constantly in pain, incontinent of urine or faeces, bearing a heavy burden of sadness in discovering their child stillborn, ashamed of a rank personal offensiveness, abandoned therefore by their husbands, outcasts of society, unemployable except in the fields, they live, they exist, without friends and without hope. Because their injuries are pudendal, affecting those parts of the body which must be hidden from view and which a woman may not in modesty easily speak, they endure their injuries in silent shame. No charitable organization becomes aware of them. Their misery is utter, lonely, and complete.