Taking Care of my Gynecological Health Is a Feminist Act

Embarrassing. Gross. Painful. Uncomfortable.

These are just some of the words that come to mind when I think of all the things I’ve heard and read throughout my life about the experience of going to the gynecologist.

Since I’ve started taking charge of my own gynecological health, I’ve been thinking more about what these words. What do they mean in broader context of the female experience, the female body, and feminism in general?

My experience with feminism comes through academic and scholarly research, and through conversations with women from around the world about feminist issues. Through both, I’ve come to learn how important it is for women to be able to own their bodies.

The culture and religion around me have always told me that my body is bad, sinful and dangerous, and that I should somehow separate myself from it.

This message has had a particularly negative consequence in my life in relation to an anxiety disorder that began in childhood. Anxiety makes me feel out of control – and particularly out of control of how my body is reacting.

I’ve also been told by religion and culture that I should separate my body and my mind from my soul. Through my work in therapy and research however, I’ve been learning that I don’t have to separate these parts of me. They all work together to make me the person I really am. I cannot fully inhabit myself or fully be in the world if my mind, body and soul are disconnected.

And so, I’ve been learning how to inhabit my own body. Most importantly, I’ve been learning how to care for it – including for my gynecological health.

Uterus, cervix, vagina and vulva are not dirty or embarrassing words.

They are part of my body and of who I am, and to care for my overall health and well-being I must take care of them.

During my latest Pap test (also called a Pap smear or smear test), I experienced quite a lot of discomfort and even pain. (Most people don’t experience pain during these tests. However, there are some reasons why pain might occur, so it’s vital to be open and honest with your health provider.)

I spoke up as soon as I began to feel pain. I said it loud and clear and my provider heard me. She kindly apologized for the discomfort and pain I was experiencing and moved slowly while walking me through the whole process. She kept checking in on me – “How are you doing now? Are you hanging in there?” – and I kept speaking up whenever something hurt or became uncomfortable. In just a few minutes, the exam was over. The relief of knowing I had done something so important for my health was worth the temporary pain and discomfort.

At the end of the appointment, I felt proud of myself and empowered because I spoke up instead of keeping quiet when things didn’t feel right in my body.

Saying “That hurts!” was not just a good way for my provider to better care for me, but also for me to take some control of my body in a situation where I didn’t have full control of it.

Despite the discomfort, I felt connected with all parts of myself during the experience of my gynecological exam. Because of my anxiety, I had been doing a lot of grounding and breathing exercises to prepare. I made sure I was fully engaged in the conversation with my provider, listening to her advice and tips and answering her questions honestly and openly.

By taking time out of my day to focus entirely on myself and my body, I felt like I was finally validating my body’s existence and needs in all its complexities. The female reproductive system is a marvellously complex world of its own. I was speaking up against the voices that have told me that my body is dirty and shameful, and saying loud and clear, “No! My body is good and an essential part of me that deserves care and love.”

Taking control and care of my body are concepts that are becoming increasingly vital to how I live my life.

I wholeheartedly believe that doing so – even through something as routine as attending a gynecological exam – is a feminist act.

Motherhood in Conflict: Colleen’s Story

In northern Uganda, many mothers have lived through armed conflict. Some gave birth in a time when murder, abduction, mutilation and rape were common practices. It was a time when child soldiers were forced to kill loved ones. What would it be like to become and be a mother in this context?

Colleen* is one of the women I grew very close to during my time volunteering in a counselling centre in Northern Uganda. Like Achola, she told me about her experiences of motherhood during and after the war.

Becoming a Mother in a Conflict Zone

I visited Colleen at her home in rural Ngetta, close to the city of Lira in the northern part of Uganda. The region has been badly affected by the Lord’s Resistance Army (LRA) insurgency. There were great consequences for all, and especially for pregnant women and mothers.

Colleen told me that she was abducted by rebels from the LRA when she was only 15. She escaped them by hiding in the open stem of a bush. Colleen told me that she became a mother at the same time as losing both of her parents, who were killed by the rebels. She spoke about how hard it was to flee from the rebels night after night, while ensuring the safety of her siblings and her baby.

Colleen’s experiences of the war have been debilitating, and she is still recovering. Though the war ended more than a decade ago, Colleen continues to be in emotional and physical pain. She tells me:

“When I was with my baby hiding in the bush, somebody stepped on my waist. It affected my waist so much up to date. Whenever I laugh, I could just fall unconscious for some minutes. It is still painful.”

What is very striking about Colleen’s story is that it demonstrates that life after war can still be filled with terror. For Colleen, the days of violence are not over.

‘Post-Conflict’ Motherhood

Just after Colleen had been abducted by the rebels, she was married at 16 to her current husband. The day I spoke with her, he was out working on nearby land. Colleen leaned towards me and whispered in my ear:

“I never wanted to marry him, my brothers forced me to marry him cause they needed money and animals [bride price] so that they can marry their wives.”

The practice of bride price is one of many practices that highlight the negative effects of poverty and patriarchy on women’s wellbeing.

The women I worked with told me that in their communities, girls are usually seen as a commodity by both their natal family and their new husband. As soon as a girl is born, she is a source of income for her family. This puts girls and young women at great risk of being forced into early or childhood marriage. This is exactly what happened to Colleen.

Colleen is now in an unhappy and abusive marriage. The years of grabbing her children and running into the bush have not been forgotten. These days, however, when she runs with her children it is not to escape the rebels, but the violence of her husband.

For Colleen, instead of a safe place, her home is a place of terror.

The end of the conflict with the Lord’s Resistance Army was supposedly meant to be time of peace. For many women, however, peace-time violence continues to disrupt and negatively influence their well-being.

Colleen’s Way Forward

Though Colleen’s daily life is characterized by the violent relationship with her husband, it does not define her. Colleen experiences a lot of joy in the relationship with her children, and with her female friends who she meets in her neighbourhood and in the local counselling centre. The women often sing and dance together:

“During the rebel time there was no music, now there is music and we can dance and feel better. I dance! … I always dance and listen [to music] because it is telling me about peace, if it is gospel it is counselling me also. There are songs which you listen to and it teaches you about peace.”

Community groups, the church, gospel songs and the local counselling centre are all crucial for Colleen’s recovery. We need to acknowledge the importance of creativity and body work in psycho-social and mental health support. For Colleen, dancing and singing is not only simply enjoyable, it also offers a way of healing.  

*Colleen is a pseudonym. The image accompanying this article does not depict the woman who told this story.

Obstetric Fistula is a Physical & Mental Health Priority

“It’s been three years now, I can’t wear underwear, urine is always leaking. I have developed sores on my genitals that aren’t healing because of the moisture. I dread going out in public.

The last time I went to a gathering, people distanced themselves from me because of the bad smell. I repelled them. I’m confined to this house so I can bathe each time I soil myself. My entire family believes I was cursed, they say no one has ever had a disease like mine before.”

Nyaradzai is a 19-year-old living in my community in Mashonaland, Zimbabwe. She is one of many women suffering from obstetric fistula. 

Like many others, Nyaradzai has been unaware that hers is a condition that needs medical attention. She tells me her story:

“Three years ago, I dropped out of school. I was pregnant. My parents chased me from my home, so I went to stay at my boyfriend’s house. He was still in high school too, but his parents accepted me. I stayed there for six months. 

My baby died while I was in labour. It took me 6 hours to get to the nearest clinic – I was walking because my in-laws couldn’t afford to hire an ambulance to take me there. When I arrived, the nurses ignored me. In fact, they scolded me for getting pregnant at such a tender age. I was 16 at the time. While I was in labor, I passed out. I can’t recall what happened, but when I gained consciousness, I was in so much pain.

When my in-laws heard that I had delivered a stillborn baby, they called me a witch and returned me to my parents’ house. My problems started a few days later.

At first, I thought I just wasn’t making it to the toilet in time, but I was also wetting the bed at night. Now when I go to sleep I take a cloth and place it between my legs and put a plastic sheet underneath me so I won’t wet the bed. I can’t wear underwear because of the sores on my genitals.”

Nyaradzai’s story could be the story of many women living with fistula in Zimbabwe.

Fistula is a silent condition, and as a result many women are suffering in silence. Huge numbers of people are not aware of what it is or what it means for women.

A fistula is a passage or hole that has formed between two organs. Obstetric fistula is an abnormal opening that develops between the birth canal and the urinary tract. It is the primary type of fistula affecting women in developing countries.

Obstetric fistula is caused by lack of access to quality obstetric care, particularly prolonged and obstructed labour without treatment. Young girls can be at high risk, as their birth canals are still narrow. The head of the baby causes a tear between the birth canal and the bladder or rectum which, if not surgically repaired, leaves women incontinent.

2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are living with fistula. 

As Nyaradzai has experienced, the social isolation associated with physical symptoms can have significant mental health consequences. Obstetric fistula is almost entirely preventable, and its prevalence in the world is a sign that health systems are failing women.

I share Nyaradzai’s story today, on International Day to End Obstetric Fistula, to try to break the silence.  

It is important that we talk about fistula, teach communities about it and encourage women to help one another through education, empowerment and delaying marriage and child bearing.

Read more on girlsglobe.org and join the conversation online using #EndFistula.

Motherhood in Conflict: Achola’s Story

“Women, in short, lack essential support for leading lives that are fully human. This lack of support is frequently caused by their being women.”
– Martha Nussbaum

Across the globe, mothers face difficulties in relation to their experiences of motherhood and well-being. Many of these are recognizable across countries and cultures.

Becoming and being a mother in the context of a conflict lasting over two decades, however, is different. For these women, their highly dangerous situation means daily care of her children becomes a matter of life and death. This was, and arguably still is, the case for many of the women in northern Uganda.

Before I went to volunteer in a women’s counselling centre in Uganda in 2018, I had prepared myself appropriately. Or so I thought. I watched documentaries on the government’s conflict with the Lord’s Resistance Army. I read loads of newspaper interviews, academic articles and NGO reports, and I spoke with professionals in the field.

All of my preparation, however, still came nowhere near to a full picture of what womanhood, and particularly motherhood, during and after war looks like.

Becoming a Mother in a Conflict Zone

During times of war, stories of motherhood – and female experience in general – have been excluded and unexplored. It is time this silence, often resulting from gender blindness, is broken.

To understand maternal well-being in a post-war context, we must realize what women had to deal with specific to their role as a mother.

The following story was told to me by Achola*. Achola is a 54 year old widow, with 8 children. I visited her home in rural Ngetta, close to the city of Lira in the northern part of Uganda. This region has been badly affected by the Lord’s Resistance Army insurgency, which had great consequences for all, and especially for pregnant women and mothers.

Pregnancy can be a challenging time for women anywhere in the world, and especially for women in impoverished regions.

The challenges Achola faced just became bigger and bigger after giving birth. Only two days post-birth, she had to run to a nearby mountain to find safety from the rebels. Her husband ran in a different direction and so she sat alone with their new-born baby.

“We were sleeping in the hut when the rebels came in 2002. I had a baby child and heard a gunshot. I came out and ran into the bush. The child was only two days old. We were hiding at a swamp and throughout it all the body was shaking.”

With no clean toilets, nothing to withhold the bleeding, no painkillers, no food, no emotional support, fear overtook Achola. At this point, she thought about killing her new-born baby.

“I felt like killing the baby I have so that I am left alone. Because I felt I was going to die, the rebel was going to kill me. There were no merits, that was just the sadness showing. I was full of sadness, and the feeling came from fear. Fear was the one thing making me think that … It was so painful, it was so painful in my heart.”

Like all the other families in the area, Achola had to run away from home every few nights for months in a row.

Hiding in the bush, however, came with great dangers and consequences – 5 tombs next to Achola’s hut are a painful and visual reminder of this.

“Those are the bodies of the children … I cannot recall when those children died. I gave birth to thirteen children, now there are eight … they could not even sit, they could not even crawl.

It happened as a result of running to the bush with these children, the mosquitos bit us in the bush and gave them malaria, then that child dies later on like that.”

Achola’s Way Forward

Achola suffered tremendous losses during the war. She tells me that she “cried and cried and cried for many years.” Today, however, she says: “I am feeling better and better slowly, it is not like in the past. I can laugh.

The community counselling centre, run by Ugandan psychologist and trauma specialist Sister Florence, has helped a lot: “I am now recovering from these problems and this pain … I am now getting energy and feeling better.”

Reconnecting with her body has helped Achola in overcoming some of her struggles. Besides the counselling centre, the church is a major source of social support for her. The word of God, according to Achola, is a form of counselling: “I am always counselled from there [church] by the word of God. When I’m in problem and I hear the word of God I always feel better.”

By sharing this story and trying to understand the complexity of post-conflict issues, we can move on from merely reading narratives of pain and loss.

Instead, we can focus on what helps women live more fulfilling lives after conflict – and how we can support them in their journey.

*Achola is a pseudonym. The image accompanying this article does not depict the woman who told this story.

Ola Abu Alghaib: an activist for women with disabilities

In November, we wrote about an amazing conference. It was born from the realization that women’s leadership needs to be a priority in the health ‘business’ landscape. Not only because women’s voices should be present at the ‘decision making table’, but also because a new narrative on leadership is needed for all the young women and girls out there.

Girls need female role models to look up to. They need role models who can inspire them to work towards their own goals and tell them that nothing is impossible. Role models who say: ‘you can, and should, fight like a girl in order to become whoever you want to be!’

Inspired by this feeling, Swedish Organization for Global Health wants to share the story of some of these role models. We hope you will feel inspired and relate to them. Maybe you’ll even decide that, yes, this is exactly what I would like to do too!

First up is Ola Abu Alghaib, the current Director of Global Influencing and Research at Leonard Cheshire – an organization supporting people with disability to achieve their goals and live life at their very best.

Photo credit: Ola Abu Alghaib

Ola embodies the real meaning of the word activist.

Her job is to fight for the rights of those who are generally underrepresented or even ignored by society – women and men who live with some form of disability. Her work tells you exactly what kind of person she is, but it doesn’t tell you for how long she has been an activist, or why she became one.

Her life is the expression of leadership. Ola was born north of Nablus, West Bank, in Palestine. Like every child, she had many dreams and goals for her life.

When she was just 14 years old she underwent surgery, but a mistake during the operation resulted in Ola losing the ability to walk or move her right hand. Ola says, “this was obviously very shocking, but it didn’t change who I was and what I wanted to achieve in life”.

However, she soon realized that people around her started to see her differently. Many thought she could not live a ‘normal’ life, that she was broken, and that the only option she had left was to survive. Ola proved those people wrong. She was, and continues to be, a very determined and ambitious woman.

She is not just writing her own story but is also influencing the lives of others on her way.

After completing her first degree, Ola came across the German Organization for the Disabled, who decided to invest in this smart woman. Through them, she started to work in a rehabilitation center that supported people with disabilities. In the following 8 years at the center, she was aware that she was the only woman working there.

She felt that women with disabilities were not being given the opportunities they deserve, and knew was time for NGOs to act and involve more people. However, the issue seemed to fall on deaf ears. Her response?

Ola founded Stars of Hope. Their mission is to abolish disability and gender discrimination, while empowering women with disabilities to achieve their goals.

From that first step into advocacy, Ola has done so much work to bring the voices of women with disabilities into decision making rooms, such as the UN disability committee.

“Access to services continues to be a challenge for women,” she says. Influencing policy is fundamental to changing that.”

Ola has often underlined her belief that women with disabilities are generally forgotten by the feminist movement. She says this happens because disability-related issues make things even more complicated for women’s rights advocacy, but also because women with disabilities don’t ask to sit at the table. She says:

(1) We need to understand what disability means for a woman
(2) We must make sure disability receives as much attention as any other issue
(3) Women with disabilities need to demand their seat at the table

When I asked what leadership means to her, Ola told me: “Leadership is the privilege that comes with it”. If you are a leader, you should use that position to make your own contribution to improve things for others.

If you are a girl or a woman who feels, “I can’t be a leader,” and if you are suffering because of the way society defines you, Ola has this piece of advice: “The world is changing so take the lead and be determined, starting in your household.”

Feeling inspired by Ola’s story? Are you a woman with disabilities and want to become a leader in global health? Check out the following links that could give you some ideas about where to start, but remember – everything always starts from within, from you.

Ashoka Fellowship
Google Europe Students with Disability Scholarship
Wellcome Trust fellowships/scholarships

Put Aside Your Stethoscope & Listen to Women’s Pain

It was sudden, debilitating pain that would come out of the blue. It just kept getting worse. Eventually, I ended up in hospital.

The emergency room doctor sent me home with no leads on the cause of my pain. He told me to follow up with my primary care physician, and so I made an appointment.

As I sat in my lovely exam gown waiting, my mind went to dark places about what this pain could possibly be. “I really hope the doctor will have some thoughts on this,” I thought. “I hope he’ll be able to reassure me somehow.”

He didn’t. Instead, he asked me two questions and mumbled something while scribbling on his prescription pad. He shoved the paper in my face and told me to pick it up at the pharmacy.

Before I had time to decipher the handwriting, he was gone. Securing the back of my gown with one hand, I jumped off the exam table and chased him down the hallway.

I don’t embarrass easily, so I didn’t care that I was running around in a paper-thin gown while other patients gave me the side eye.

“I’m not done, I have questions” I said. Visibly annoyed, he followed me back into the exam room.

I hopped back onto the table while still holding my gown closed, impressed with my own acrobatic abilities. But I was even more impressed with my boldness. Where had it come from?

I was taught that doctors are powerful and mighty. They shouldn’t be questioned, only readily and blindly trusted.

Yet, here I was, demanding he take the time to answer my questions.

“What are the side effects?” I asked.
He smirked.
“There are very few. This is a very common medication for stomach upset.”
“Stomach upset? I’m having sharp pains. And they’re not going away.”
“You’ll be fine. Just take the medication as prescribed.”
“But what do you think is causing it?”
“Take the medicine and if it doesn’t work, call us.”
“Do you need to do any tests?”

“Tests?” he said. “We don’t need to do any tests. It’s probably just gas.”

This was useless. I’ve made plenty of excuses for doctors like him before: he’s busy, he’s stressed, maybe it’s the nature of the job.

The truth was, he just didn’t care.

At home, I began to read the little pamphlet inside the box of medication. Did it really state that caution should be taken with Asian patients due to higher risk of side effects?

But…I’m Asian?

I made an appointment with a new doctor. A woman. By now, the pain was worse and more frequent. I had done some research on my symptoms and was starting to think it it lined up with some form of dietary sensitivity. There was a pretty clear pattern and I’d been taking detailed notes.

The doctor was an older woman with a commanding presence. “She’ll listen,” I thought. “She’s a woman.”

Instead, she dismissed everything I shared and everything I asked. She attributed the skin breakouts around my elbows to a type of spider bite.

“So you think it’s a coincidence that I have these breakouts every time I eat bread?” I asked. She actually rolled her eyes. Finally, she agreed to test for celiac disease, saying it was nearly impossible that I had it.

The test was negative. I started to feel like a hypochondriac. Was I making these symptoms up?

I reminded myself that dismissal of symptoms are a reality of health care for women, and that I’d have to fight to be listened to.

In my appointment with a third doctor, she shook my hand warmly. But she scrunched up her eyebrows as I explained my symptoms and gluten theory. “Here it comes,” I thought. “She’s going to tell me I’m imagining this.”

The doctor scooted closer to me and said, “You know, there is a test for celiac disease but not gluten sensitivity. It sounds possible that your body is reacting negatively.” She paused, and then said, “My goodness, it must’ve been frustrating dealing with this.”

My mouth dropped open. She went on to share next steps and review possible treatment options. She even asked me about my thoughts on my symptoms. I walked out feeling informed and validated.

Listening is one of the most healing forms of medicine.

To know we’re not alone is a powerful form of treatment. Hear us. Believe us. Put aside your stethoscopes for a moment and listen with your hearts.