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Incontinence African scourge

As many as 3 million girls and women in the developing world without access to medical care suffer from a childbearing condition that leaves them chronically incontinent, isolated from their community and depressed to the point of being suicidal.

Two members of the U.S. Congress, a group of documentary filmmakers and the United Nations Population Fund (UNFPA) are trying to raise awareness of obstetric fistula — a rupture between a woman's womb and bladder or womb and rectum that occurs during obstructed labor. Without basic medical care, obstructed labor can easily last for days, usually ending in a stillbirth.

Affected women, many of whom are teenagers in rural sub-Saharan Africa, suffer shame and rejection from their families because they cannot control their urine or feces and do not understand why. They are usually driven from their homes and cannot hold regular jobs, take public transportation or even walk in public because of the stench.

"Surely we can all agree that this devastating condition is worth everything we can do against it," Rep. Carolyn B. Maloney, New York Democrat, said in a statement Friday, delivered in conjunction with a press conference presenting the new film "A Walk to Beautiful."

The film, released by Engel Entertainment, chronicles the struggle of five Ethiopian girls and women with obstetric fistulas and each one's journey to the Addis Ababa Fistula Hospital, where they receive successful corrective surgery that costs as little as $300.

One of the girls, a 17-year-old named Yenenesh, was pregnant at 13 and in labor for three days before she gave birth to a dead baby. "I'd rather have my arm cut off than have this problem," she says in the film, close to tears.

Obstetric fistula occurs in rural, underdeveloped societies where a poor diet causes women to have smaller bodies. An absence of basic medical services forces them to undergo dangerous child deliveries.

The condition, common in the United States in the 19th century, is avoided in the industrialized world largely through Caesarian sections. Ethiopia, a country of 76.5 million people, today has 104 obstetrician/gynecologists, only about half of whom are practicing, said Sarah Craven, a UNFPA specialist on women's reproductive health.

While many girls in sub-Saharan Africa marry and are pregnant before their bodies have fully developed, film director Mary Olive Smith said the root causes of obstetric fistula are economic.

"There's this direct correlation with poverty. We were careful not to show this as an issue of culture," she said.

Rep. Michael M. Honda, California Democrat, and Mrs. Maloney are co-sponsoring for the sixth year in a row legislation that would provide $34 million to UNFPA's campaign to end fistula. The White House has blocked five previous attempts to secure the money because of a family planning program UNFPA operates in China, according to Mrs. Maloney's office.

Mr. Honda has also requested federal money in fiscal year 2008 to help expand the Addis Ababa Fistula Hospital, including the construction of field clinics.

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