Say Anarcha

I spent a few weeks recently reading Say Anarcha, a nonfiction book that tells the story of the woman who has usually been obscured in the history of gynecology. Anarcha was Black and enslaved, and in an early pregnancy developed obstetric fistulas, which are holes between the uterus and bladder or the uterus and rectum. Anarcha had both types.

An obstetric fistula leaves the injured woman with urine or feces (or both) leaking out of her vagina, which is just as bad as it sounds — medically, personally, and culturally. At a minimum they are social outcasts because they smell, but often they are literally thought to be cursed.

It's still a bit mysterious to me why the fistulas happen, but mostly they appear to be more common when young girls give birth or when a baby is too large or breach. These days, when medical care is available, a C-section would be performed to prevent the possibility. Basically, the holes develop when the birthing woman labors too long, tissue dies, and part of the uterus disintegrates.

This is my layperson's way of explaining it, though as a person who has given birth, I don't remember ever hearing about this as a possible complication, or a reason why C-section might be performed. It's not common in the U.S. anymore, but it's likely that in the 19th century the U.S. rate was similar to or worse than what it is currently in the rural parts of Africa and Asia that have the highest rates (as high as 2% of women aged 15–49 in Uganda, for instance, according to one study).

J. Marion Sims, the doctor who experimented on Anarcha and other enslaved women — and later women who were not enslaved — is credited as one of the founders of modern gynecology. Sims is the other major subject of Say Anarcha, and author Hallman makes it clear that Sims hated the idea of medical ethics and thought they would be the downfall of medicine.

In addition to experimenting on enslaved people, Sims also made forays into female genital mutilation as a way of curing depression and "inappropriate" attitudes of women, and his unwavering belief that infertility could only be the fault of woman led him to hack away at cervices and other female parts to make it easier for sperm to reach their target.

The man owned a device called a uterine guillotine, for god's sake (yes, that was its name):

Fear of surgery was an ongoing problem. Some [white] women stormed off with mutterings of butchery when explained the procedures for cervical incision and amputation.... Thankfully, husbands knew their wives' best interest: they provided the consent that the dastardly new ethical constrictions placed on him (page 271).

I wasn't sure I would write here about Say Anarcha, though I wanted to, because it was a bit overwhelming.

But then I saw this on Twitter:

I have never been so radically pro-body autonomy than lying here, 40 weeks pregnant, feeling like I'm going to actually die any minute. No one should be forced to be pregnant. It should always be a choice. Adoption is not an alternative to experiencing pregnancy.

I keep thinking of the 12yo kids they want to force to experience this and want to set something on fire. I keep thinking about those pregnant and in medical crisis waiting until they are nearly dying before they can get care. I'm angry. Deep in my bones angry.

The woman who wrote that is a medical sociologist and health disparities scholar at UCLA.

When she mentioned 12-year-olds giving birth, it made me think of Anarcha and the present-day women who live with fistula injuries, described in the closing part of Say Anarcha. Many of them acquired their fistula injuries as child brides.  

As if there needed to be one more reason, obstetric fistula is a mostly unknown physical aspect of why children should not be giving birth, and why there shouldn't be child brides.