Chapter 2: Treating health problems
After you have asked everyone “why” in this way for some time, you will find
that there are many reasons why Elena had anemia. This exercise also shows why
anemia is not just a problem for Elena but for most of the women in the village.
Indeed, it is a problem for most women in most villages and poor communities
around the world.
Look deeply to prevent more problems
Finding the many root causes of health problems means
looking hard at the different parts of people’s lives that
contribute to the problem.
For example: A fistula is a terrible complication of
some births. When a labor goes on much too long, the
tissue inside a woman’s vagina can become crushed and
break open, leaving a hole to her bladder. This causes
serious health problems and constant leaking of
urine. To prevent a fistula, simply prevent a long
labor. If a woman is in labor for more than a day,
bring her to a medical center or hospital.
But by looking more deeply at the many
causes of a long labor, we can do more to
prevent fistula and other related problems.
• Young girls who do not eat well often grow up to have small bones
(including small pelvises). An abnormally small pelvis can cause a
long labor. Some young girls do not eat enough because their
families cannot afford food. Some are not fed enough because they
are not considered as important as boys.
• Some girls have children too young. Young girls have long,
complicated labors because their bodies have not fully grown. Girls
might marry and have children early because it is the custom of their
communities or because their parents are poor and cannot care for
them. Or both.
• Women in bad health are more likely to have long, complicated
labors. Anyone can have health problems, but those who do not
have access to basic health care are in the greatest danger.
• Rural and poor women cannot easily get medical help in an
To prevent fistulas, must we simply get women to hospitals faster,
or can we also work to change the conditions that cause long labors,
like poor nutrition of young girls and too-early marriage and childbirth?
How can we work to stop the root causes of these problems — poverty
and unfair treatment of women and girls?
A Book for Midwives (2010)