Catholic Medical Quarterly Volume 72(1) February 2022

Faith in Medicine

Images from Africa:
Protecting women from abuse and STI’s

Catherine ManghamA friend of mine spent 3 months volunteering as a legal Advocate on an island near Lesbos in 2019. Most of the refugees who came to see her were sub-Saharan African women who were fleeing from gender-based oppression and violence.

I went to Uganda for a few weeks one year to help out a friend, who, supported by her husband, had committed 2 years as a missionary doctor there. She had been raped and threatened with a machete while out running her usual circuit one evening after work.

One of the patients she handed over to me, whom she was very worried about, was a girl who had been unresponsive since admission. Noticing that she had a drip up and no catheter, I felt the bed beneath her, and asked her family, who were taking care of her in hospital, what happened when she needed to pee. They told me that she got up and went to the washroom. With the family outside the door, I managed to glean from her that she was being forced into an unwelcome marriage. Somewhat questionably, I told the family that if they insisted on trying to marry her to men she did not want, she might well get sick again.

The young female doctors taking the diploma in Tropical Medicine with me in Liverpool 2018, were outraged when I suggested that the logical follow up, with regard to pregnancy prevention and sexual health, would be an exploration of abstinence in the first instance. For me, it seemed that pregnancy and sexually transmitted infections and gender-based violence were part of a contin- uum of life experience. That encouraging both men and women to learn and practice communi- cation, continence and self-control around the issue of sexual relations, could provide a first line strategy for prevention of pregnancy and STIs and gender-based violence. Charity begins at home, after all. To avoid this delicate topic and default straight to contraception and condoms, seemed to me to miss an opportunity to address a fundamental imbalance of power and smacks of easy, short term thinking, and unexpected consequences.

The young woman, who seemed to speak for the rest of the class of 60, mostly 25-35 year olds, retorted that women just wanted to have fun. I responded that women in Africa don’t seem to be having much fun! Women who are forced to walk to collect water for several miles, unprotected by their menfolk who are away looking for work, are sitting ducks for the kind of opportunist my friend had been attacked by. It is a not infrequent occurrence. It suggests a culture in which there is little accountability or attempt to bring the perpetrators to justice.

Closer to home, in Africa, rape is only rape if the man is completely unknown to the woman. The implications of such a statement are that men have a right to use women for their own ends. There is little acknowledgement that women have a right to make their own choices. And yet, it is women elders in the community who often carry out Female Genital Mutilation and men in families are often in a hierarchical web of beholdedness and responsibility. The web of domestic power politics is complex indeed.

Contraception can provide a short term solution to the injustice of gender inequality. It can free a woman to work and a family from ever increasing poverty, trying to feed more and more mouths; but it cannot address the fundamental problem. In fact, it may well make matters worse, in that the perception of men can be that women want to control their own fertility, in secret, behind the backs of the men in their lives, engendering mis- trust and paranoia. Women who can prevent pregnancies, could be having sex with anyone… if there is a very low risk of pregnancy occurring, what cause would a woman have to say “No” except because she no longer loves her husband or that she is loving someone else… or, God for- bid, that she is too tired from her other labours to be available to her husband. Of course, the irony is that the men who are supposedly involved in these clandestine encounters are never responsible.

Luckily, the worries of infertility which seem to be gathering pace in the West, seem a less pressing issue at the moment in Africa, except for the “barren” wife who is cast aside with no status at all. But if women in Africa start to delay pregnancy for the sake of careers or self-determi- nation, then watch this spot. The biggest lie that contraception has brought with it, is that we canbe completely in control of our fertility.