At age thirteen while in primary school in a rural village in western Kenya, Kwamboka W. had sex for the first time. She had no information about contraception and used no protection during sex. Three months later, Kwamboka was shocked to discover that she was pregnant because, as she told me in an interview seven years later in 2009, “It was my first time and I did not think I would get pregnant.” Kwamboka was more shocked when she later discovered, after laboring for close to three days and delivering a stillborn baby, that she could not control the flow of her urine and stool.

Years later, the pain—both physical and psychological—was still vividly seared in her memory. “My mother tells me, ‘You can’t get married; how can you go to someone’s home when you are like this? They will despise you.’ I was traumatized,” she said. “I thought I should kill myself. You can’t walk with people. They laugh at you. You can’t travel; you are constantly in pain. It is so uncomfortable when you sleep. You go near people and they say urine smells and they are looking directly at you and talking in low tones. It hurt so much, I thought I should die.”

Africa places a high premium on childbearing. However, for hundreds of thousands of women in the continent, giving birth can mean death or living death.

Kwamboka was just one of the more than fifty women and girls I interviewed in 2009 in Kenya who suffered obstetric fistula, an entirely preventable and treatable childbirth injury that leaves women and girls with urinary or fecal incontinence. It is caused by prolonged, obstructed labor—a condition that accounts for 8 percent of maternal deaths worldwide—without access to emergency obstetric care, usually a Caesarean section. During the prolonged obstructed labor, the soft tissues of the birth canal are compressed between the descending head of the fetus and the woman’s pelvic bone. The lack of blood flow causes tissue to die, creating a hole (fistula in Latin) between the woman’s vagina and bladder (vesico-vaginal fistula or VVF) or between the vagina and rectum (recto-vaginal fistula or RVF), or both. Many women live with fistula for several years or for the rest of their life, if unable to access treatment.