Dr. Lauri Romanzi

Dr. Lauri Romanzi is a member of  the Medical Advisory Board of Women’s Voices for Change. Last year, at the age of 54, Dr. Romanzi closed her Manhattan office to work in Africa as a Pelvic Reconstructive Surgeon, repairing the devastating damage created by obstetric fistula (see the story below) and female genital mutilation, as well as addressing other pelvic floor disorders, including incontinence, prolapse, and the need for uterine resuspension. She spent a month aboard Mercy Ships  in Togo, then another month at Edna Adan Maternity Hospital in Somaliland, then Senegal, then Nepal, then three months in Afghanistan, then back to Somaliland and back again to Mercy Ships, sharing skills, building capacity, creating new and sustainable possibilities in each place. “I chose not to wait until retirement to do this work,” she says. “It was time to do what my international colleagues requested of me—that I take them as seriously as they take themselves. I chose Yes to this work, and I chose Now. Or rather, Yes and Now chose me. There was no other humane or ethical course of action.” —Ed.

I just finished watching a video of two educated, middle-class American men hooked up to machines that simulate the contractions of childbirth. The experience transformed them. At the end, one of them thanked his mother in a way he would otherwise never have done. You know that they now know what they could not possibly have otherwise known about the harsh realities of childbirth. Their pre-“labor” bonding over the “tendency of all women to exaggerate everything” notwithstanding, these men deserve a round of applause.

Here, in the U.S., where women risk 21 maternal deaths per 100,000 births and where obstructed labor has been eradicated by modern obstetric practices that effectively intervene when the baby “just won’t come out,” these men survived one . . . whole . . . hour of simulated labor pains. Their wives—who high-five over cups of coffee as their husbands say things like “STOP smiling!”—ran a real-life risk of maternal mortality that is 26 to 48 times lower than that of women in sub-Saharan Africa.

If I could, I would take these newly savvy males aboard Africa Mercy, a surgical hospital ship that cruises the coast of West Africa, treating patients in each port, or to Edna Adan Maternity Hospital in Somaliland, or to Panzi Hospital in the Democratic Republic of Congo, or just about anywhere that most women on the planet actually live. The majority of the world’s women live not in wealthy nations, where every planned pregnancy is met with joy and the expectation of optimal outcome, but in developing nations, where each pregnancy carries a level of risk that the woman’s sisters in wealthy countries have not known since the turn of the 20th century.

At every center, our enlightened men would see patients who have endured days of obstructed labor and utterly brutal stillbirth. If they were to attempt to simulate this type of difficult childbirth, the labor simulation would go on, unabated, day in and day out, for the better part of an entire week, in a hot, dirt-floor hut, miles from the nearest road, with only an illiterate local woman to help. No car, no potable water, no medicines, no monitors, no hospital, no cell-phone service. Just you, your birthing body, and your geographically adjusted odds of 550 to 999 maternal deaths per 100,000 live births. Obstructed labor, one of the top five killers of pregnant women in poor countries, inflates this maternal mortality rate everywhere that modern obstetric care remains tragically unavailable.

Were these men to survive their five-day labor, their bodies would be destroyed—by foot drop, or by dense pelvic infection, or by the devastation of fistula, leaving them totally incontinent of urine, feces, or both. Imagine that simulation.

Obstetric fistula—an abnormal hole connecting the bladder to the vagina or the rectum to the vagina, is a virulent and tenacious threat to maternal health largely ignored by the public of wealthy nations. In 2003, the United Nations set out to increases awareness of this preventable and treatable childbirth injury with the launch of The Campaign to End Fistula; this traumatic injury had already claimed “an estimated 2 to 3 million women and girls in developing countries . . . living with obstetric fistula, a condition that has been virtually eliminated in industrialized nations.”

Imagine these two birthing-boys standing on the dock of Africa Mercy, or traveling for 10 days in the Fistula Bus from Mogadishu, Somalia, to National Boroma Fistula Hospital in Somaliland, or running through rebel-infested forests risking kidnapping, rape, and murder in the eastern region of the Democratic Republic of Congo, to arrive, exhausted, in a place that offers them the one thing they need most—hope. Women who’ve traveled for days and weeks, many on foot, covering hundreds of miles, women desperate to put their bodies back together in those few hospitals devoted to relieving the suffering of those who’ve managed to survive obstructed labor. These women have stared death in the face and endured, only to live their way into a future that includes a dead baby, divorce, banishment, and the constant flow of urine or feces. They are unable to work, socialize, or live any sort of normal life. They are shunned, starved, abject in ways no American dare imagine. This despite the fact that the world’s first fistula hospital was built in the late 1800s in New York City to serve American women suffering this exact tragedy. How quickly, we forget—like labor pains—our histories of unhappiness.

These countries are the places where Mercy Ships, Fistula Foundation, UNFPA, USAID, and other dedicated government and nonprofit charitable organizations have restored the lives of an endless stream of fistula victims, funding surgical training and paying hospital fees in poverty-stricken fistula zones of Africa and Asia, working together in a global mission to both treat and prevent obstetric fistula. You find these programs at Edna Adan Hospital and National Boroma Fistula Hospital in Somaliland, in the Panzi Hospital and its 1000-km outreach program in South Kivu, Democratic Republic of Congo, in Gondar University Hospital in Ethiopia, in Maputo General Hospital, Mozambique, in Dhaka Medical College, Bangladesh—in so many places where the ravages of obstructed labor continue unabated. It’s a big world, where, for most women, pregnancy remains fraught with terrible risks.

Wouldn’t it be magical if these two men, having reaped the enlightening rewards of a U.S.-style labor simulation, could have their perceptions transformed yet again—to the childbearing realities lived by the overwhelming majority of the world’s women? The time has come for these two daredevils and all of their American brothers to not only embrace the childbearing realities of their wives, but also the terrifying risks of death and disability that are the norm for most women sharing our planet. On the heels of the 10-year anniversary of the United Nations Campaign to End Fistula, which this May launched the first annual International Day to End Fistula, I  say yes, indeed, it would be magical.