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Photo Essay / Wayfinding

Spaces of Waiting: Obstetric Fistula in Niger

The work of a medical anthropologist offers a window into the world of Nigerien women who live with obstetric fistula.

Unable to access quality emergency obstetric care, millions of women across the global south, and particularly in sub-Saharan Africa, shoulder the burden of health care systems that are crippled by post-colonial politics and poverty. In sub-Saharan Africa, 1 in 36 women will eventually die from pregnancy-related complications due to health care systems that fail them. Where I work, in the West African country of Niger, the rate is even higher: 1 in 23 Nigerien women will die from maternal causes. To give some perspective, the lifetime risk for women in the United States is 1 in 3,800.

In addition to shockingly high rates of maternal mortality, for every woman who dies from obstetric complications, many more survive with chronic disabilities. This photo essay centers around women in Niger who live with and seek treatment for obstetric fistula. Fistula, a birthing injury that results in chronic incontinence of urine and/or feces, is caused by prolonged obstructed labor due to inaccessible biomedical interventions such as cesarean section and forceps delivery.

Over the course of 18 months, I followed 100 diverse women with fistula, who came from rural and urban Niger as well as neighboring countries, as they sought treatment in four fistula centers. These women’s lives are, in many ways, stories of corporeal, emotional, and social hardship. But they also encompass stories of community, family, and solidarity. Their accounts ring with laughter born of struggle and of resilience and personal growth gained through long and lonely journeys.

Alison Heller is a medical anthropologist who studies reproductive health and humanitarianism in West Africa. She received her Ph.D. from Washington University in St. Louis and is currently a traveling faculty member for the International Honors Program (IHP)/Comparative Program run by World Learning. Before starting as an assistant professor at the University of Maryland, College Park, she will complete a fellowship at the School for Advanced Research in Santa Fe, New Mexico. Heller’s research has been funded by the Fulbright-Hays Program, the National Science Foundation, and the Wenner-Gren Foundation.


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