The Hidden Tragedy of Motherhood
By Barbara McAdorey

Women in Africa give birth in appalling conditions, without basic obstetrical care, and as a result, mothers and babies suffer and die needlessly. While the international community pushes contraception and abortion to "solve" the problem, Dr. Robert Walley and MaterCare International offer real hope to mothers and babies worldwide.

Grace was 14 when she had her baby. Impregnated by an older man, she had nobody to look after her. After five days of obstructed labour, her uterus ruptured and the baby eventually died. Pounding of the baby's head on Grace's bladder and rectum left her incontinent. Grace was alone and infected until women in the village found her. In order to help her dry out, they poured boiling water on her. Grace survived after many operations, but because of the damage that had been done, Grace would never be able to have another child.

This damage to the bladder and/or rectum caused by the pounding of the baby's head during obstructed labour is called obstetric fistulae , and it was common in North America in the 19th Century. The first hospital to treat this condition opened in New York in 1875, then closed in 1920 because the problem had been eradicated due to improved health and better obstetrical care.

But obstetric fistulae remains a huge problem in the developing world today, where an estimated 2 million women (and 50-100,000 new cases each year), mostly in Africa, are suffering the consequences of this horrible condition which can leave a woman ostracized from society, divorced by her husband, and sometimes even treated like an animal. Carrying a bowl or rag between her legs, she is wet, foul-smelling, and reviled by the villagers. She may find herself begging or prostituting to support herself. Left untreated, she suffers pain, humiliation, and debility her entire life. The World Health Organization (WHO) calls it the "forgotten disease."

"It is the most obscene condition that any human being can experience," says founder of MaterCare International, Dr. Robert Walley, during a presentation in April to a group of Catholic women in Richmond , Ontario . And not enough is being done about it. "There's no international organization that provides care for mothers as its main focus-obstetric care. None," Dr. Walley says emphatically. "Not Médecins Sans Frontières (Doctors Without Borders); not the ICRC (International Committee of the Red Cross); not UNHCR (UN Refugee Agency). Nobody."

Dr. Walley, a professor of Obstetrics and Gynaecology at Memorial University in Newfoundland , founded MaterCare International (MCI) in 1995, an organization dedicated to reducing maternal mortality, morbidity, and abortion throughout the world.

Maternal Mortality and Morbidity

Maternal mortality refers to the rate of death caused by pregnancy and labour. In Africa , the risk of a woman dying as a direct cause of pregnancy and labour is 1 in 17, and in some rural areas it can be as high as 1 in 7. For comparison, in Canada it is 1 in 7,300. The causes of death are usually post-partum haemorrhage, infection, eclampsia (in which blood pressure escalates, leading to convulsions and haemorrhage) and induced abortion. In a June 1996 report, The Progress of Nations , the executive director of UNICEF commented, "It is no exaggeration to say that this is one of the most neglected tragedies of our times, when 1,600 mothers-some in their teens-die every day."

But maternal death is only the tip of the iceberg, says Dr. Walley. For every mother that dies, there are about 30 who suffer long-term damage to their health, most frequently from obstetric fistulae. The rate of health problems arising from pregnancy and labour is referred to as maternal morbidity .

The tragedy is that much of the mortality and morbidity is preventable, and obstetric fistulae is treatable. If maternal health problems have been almost totally eliminated here in Canada and the rest of the developed word, why not in Africa ? Africa has few trained doctors and nurses and inadequate facilities, and in order to change that situation, two things are needed, says Dr. Walley, "the will and the compassion." For Africa , there is neither. Women in Africa live a life of hardship. They look after the home, they are the farmers, they trudge down the road fetching buckets of water, they run the markets, and they bear the children. "Their value is inestimable," says Dr. Walley with compassion. "If you lose a mother, it's not just a mother who dies or one person who dies. All the children under five may die."

Living the Gospel of Life: advocating on behalf of mothers

But motherhood is of no political importance, says Dr. Walley. So while international organizations like WHO and UNFPA (UN Population Fund) do a lot of talking about "safe motherhood," Dr. Walley and MCI are actively doing something about it by providing essential obstetrical care wherever it is necessary. This includes such things as Caesarean sections, blood transfusions, and treatment of malaria and anaemia.

"We are there also to train the next generation, nurses and doctors and specialists. We are there to do basic research, to find new ways of doing things to improve the lives and health of mothers, wherever they may be. We will be advocates on behalf of mothers because motherhood is of no political importance in our world. You may not believe me," he says with passion to the group of women in Richmond , "you may question it, you may disagree from your own experience, but to us it is very clear that motherhood is of no political importance, and this is something we are trying to turn around." Then in reference to Pope John Paul II's Encyclical, Evangelium Vitae , he states, "We'll take up the challenge to do the work of the Gospel of Life."

In an interview with LifeCanada News on April 28, Dr. Walley talks about the difficulty he has had in trying to get funding for MCI, especially for a 60-bed Birth Trauma Centre in Ghana to treat women suffering from obstetric fistulae. "Feminists, women, anybody-they'd all tell me to get lost," he says with frustration. "They'd tell me 'well she got pregnant, she shouldn't have gotten pregnant in the first place if she's going to end up like this.'...Then they get into birth control. And I would say, 'That is irrelevant! What on earth is a birth control pill going to do for a woman who is dying of post-partum haemorrhage? And what is a condom going to do for somebody who has obstetric fistulae?' What they claim is, 'We prevented the deaths.' I said, 'Ok, you prevented her getting pregnant so she didn't die. Well what about the people who did get pregnant, who still die?'" They have no answer.

Prevention vs. Treatment

It seems that the world community today is putting all emphasis on prevention programs at the expense of treatment programs, which may help to explain why Dr. Walley has had so much difficulty trying to get funding from CIDA (the Canadian International Development Agency) for the Birth Trauma Centre. But it wasn't always this way, explains Dr. Walley.

In 1978, an important conference run by WHO took place in Alma-Ata in the Soviet Union to discuss the concept of primary health care. Before that time, the entire emphasis was on curative care, and prevention programs were virtually nonexistent. At this conference, the nations of the world agreed that there should be a new concept of health care called primary health care, "where you have a balance between promotion, prevention, curative care, and rehabilitation." The problem, says Dr. Walley, was that all sorts of people then came along wanting to get into the promotion of good health and the prevention of health problems.

"So you had dieticians, and anthropologists, and sociologists, and the women's movement, and the birth control movement, all came along and took over the World Bank and took over CIDA and others, and said, 'That's where we'll go.' But they forgot the word 'balance.' So out came curative care, and not much went into rehabilitation. It all went into promotion and prevention, so that clinicians got eased out. They don't want clinicians...And that's why I've got this placard developing in my head: The way to better health care-condoms, birth control pills, mine detectors, and nicorettes. That's all you need! Well, we know that's not what we want for ourselves. Suppose we closed all our cardiovascular units and said we're going to put all that money into quit-smoking campaigns. We're all going to be healthier. Well, you can imagine! We're complaining enough now because we have to wait a year for this operation or that operation. In the Third World , that's what they're saying. When I said we want to deploy emergency aid in Albania for the Kosovars, and the same in East Timor, I was told that to get obstetricians in there-they'd go free, but they want their expenses paid, their airfare to get there-I was told by CIDA and by Catholic relief organizations as well, both in Canada and down in the States, that this would be an irresponsible use of development funding! And I said, 'Well, where do you send your wife or your sister, or your daughter when they need to have a Caesarean section, or when they need to have some operation?' "

Safe Motherhood Initiative

The international community does agree with Dr. Walley on one thing-that there is a need to reduce maternal mortality and morbidity. But they disagree on how to accomplish that. In 1990, the World Summit for Children, chaired by Canada , took place in New York . Mulroney and Gorbachev and Reagan and Thatcher were there and they sat down and started talking about children, says Dr. Walley. But they soon realized that they couldn't talk about children without talking about mothers. And then they realized they had a problem. Maternal mortality.

"So Mulroney came out and announced to the world on behalf of Thatcher and Reagan that what we had to do was reduce the maternal mortality by 50% by the year 2000. And that's all that happened. Nothing happened. And that's why even UNICEF referred to the whole thing as a 'conspiracy of silence.' Lack of initiative. But they put all their money into abortion programs."

Using a perverse sort of logic, abortion and birth control programs become the means to reduce maternal mortality and morbidity. A means of achieving "safe motherhood." If a woman's pregnancy is aborted, or if she never becomes pregnant in the first place, then she cannot die or develop complications from childbirth. And that is the solution of the international community-birth control and access to safe abortion. "That's the policy of the World Bank. That's the policy of UNFPA. That's all their policies," says Dr. Walley. "Their policy is to reduce populations, to control populations in these kinds of situations, developing countries, and amongst refugees." In fact, the UN blocked Dr. Walley and his team from going into East Timor because they would not perform abortions.

"What do we have in Canada ?" Dr. Walley goes on to ask. "Do we just have abortion and birth control programs here? No, we have some of the finest hospitals. So that's what we want for us, but we don't want it over there." Dr. Walley again refers to how politically unimportant women in the Third World are. "These women who die, they are not voters, they are not the people who man the barricades. They are little women who die alone in villages, they have no voice."

The failure of International and Women's Groups

The international agencies have failed African women. Whereas such agencies work to prevent motherhood, MaterCare starts with a "preferential option for mothers" by providing services that mothers need.

Feminism and the Women's Movement, too, have failed African women. "In the beginning when those organizations were founded, they were against abortion," says Dr. Walley. "But then they were convinced to see this (abortion) as freeing women. And in a sense, that is what destroyed them, because if you look at it, I thought the feminist movement was about equality in every possible way including important things like equal pay. They haven't got that. They got abortion, but they haven't got equal pay."

It is as if giving women the right to abortion somehow makes all the other injustices less conspicuous-that if women have the right to abortion, they might think they have attained equality. A bone thrown to appease a barking dog. But the myriad injustices committed against women go on every day. It is curious, and sad, that women's groups do not see this, do not see what abortion really is. A violent act which could never be perpetrated on a man, abortion ends a woman's pregnancy. It ends an experience unique to women-that of bearing life. And through that violent act, the woman becomes co-conspirator in the death of her own child. Thus would abortion seem to be the ultimate denigration of women.

But it is what the United Nations agencies promote as a solution to maternal mortality and morbidity.

A Millennium Gift to Mothers

In spite of frustrations and disappointments, in spite of adversarial attitudes from women's groups and development agencies, and in spite of CIDA's stonewalling and ultimate rejection of MCI's request for funding for the Birth Trauma Centre ( see related story, "Blessed are the Peacemakers" in the next issue of LifeCanada News), Dr. Walley and his team go on. They are a committed lot, seeing their work as the fulfillment of a mission-a challenge put forth by the Holy Father to Catholic health professionals to do something extra to affirm the Gospel of Life in the new millennium. MaterCare is, as Dr. Walley calls it, "a millennium gift to mothers throughout the world and to the Church, to aid in the fight for life."- BM

For more information on MaterCare International, visit www.matercare.org

In next issue: read about MaterCare's struggle to get funding from CIDA in "Blessed are the Peacemakers."