One By One: Infibulation – a practice of female genital mutilation and how that affects obstructed labor for affected Afar women and girls

Fatuma Abubacker’s story of surviving obstructed labor in the Afar is harrowing but not unique. Afar women give birth often with little skilled assistance and in extremely rural conditions. The women may be very young, malnourished or have had many pregnancies in quick succession making their uterine muscles less capable of moving the fetus into the right position at birth. Additionally many women in Afar culture are infibulated, which is one of the most extreme forms of what we call female genital mutilation or female genital cutting. Women, like Fatuma, in the last story, have their genital areas sewn nearly entirely shut when they are infants or at age six. There is a tiny hole left through which they can urinate and through which they can have intercourse, though often painfully. Infibulation can cause additional health problems and the process of infibulation itself is very painful.

When women who have undergone infibulation go to give birth, the traditional birth attendant arrives, as Fatuma’s story goes, with a knife, the blade of which she would heat up for sterilization. The traditional birth attendant would then cut the laboring mother’s scarred vulva back open so that she might give birth. In Fatuma’s case, her closed vagina was her obstruction. Her labor ended with a deceased child and with a fistula that was too complex to ever permanently repair.

This practice is changing as a result of the grassroots work of many dedicated groups on the ground. One of One By One’s fistula prevention program partners, the Afar Pastoralist Development Association, works within their own community to educate about the issues that the Ethiopian Government calls “Harmful Traditional Practices” which include the practice of infibulation. From the standpoint of obstructed labor, infibulations, for the communities that practice it, is an important area of intervention to save the lives of mothers, babies and an important way to prevent obstetric fistula.

Our grants are going to educate the first midwives that will serve the Afar people. These newly trained Afar women will be placed at the Barbara May Women’s Health Center in Mille, which is a new hospital, that is in process. The midwives will supervise and support the newly trained birth attendants who will have more tools at their disposal to assist women in labor. Enhanced birth education for birth attendants, new midwives, and education on harmful traditional practices are just a few of the incredible grassroots programs operating out of ADPA’s Loggia office. One By One is a proud supporter and with your help, more women and girls can survive and thrive in the Afar region!