The Mapping Midwife

You might raise an eyebrow when you hear a midwife talking about geomapping instead of delivering babies during her christmas break. But didn’t I tell you this blog would cross all sorts of borders? If you would like to discover the actually pretty obvious link between geomapping and midwifery or you want to volunteer in humanitarian mapping, then this blog is for you.


‘Cutting season’

Let me take you to rural Tanzania, to the northern Serengeti district, not far from the famous Maasai Mara. Nomadic pastoralism and a farming lifestyle are common here. Every even-numbered year in December, the so called ‘cutting season’ starts, a cultural practice in which many young girls and women are subjected to female genital mutilation. This basically boils down to all sorts of procedures that lead to the “partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons” (WHO).

Obstetric and Health Risks

Girls who undergo FGM run immediate health risks such as excessive bleeding, not seldom leading to death. They are vulnerable to all sorts of (chronic) infections, from wound infections, tetanus, gynaecological infections like STDs among which HIV, to cysts. Apart from psychological trauma, FGM can trouble normal body functions and lead to urinary, menstruation and sexual difficulties. Women who have been subjected to FGM also run a higher risk of all sorts of obstetric (sometimes life threatening) complications such as difficult and/or prolonged labour, obstetric tears or lacerations (fistula) and post-partum bleeding. These complications may lead to an increased prevalence of distressed babies, intrapartum stillbirth and neonatal death. Fighting FGM is important in reducing the maternal and neonatal morbidity and mortality rate, which is still pretty high in the countries involved.


Outlawed but ongoing

There are around 30 countries worldwide where FGM is concentrated, most of which are in Africa, Asia and the Middle East. Besides, some immigrant communities in western countries practice FGM. Recently, UNICEF estimated that more than 125 million living girls and women have undergone FGM, while up to 30 million girls may be at risk if the current trend does not change. Tanzania is one of these countries. Even though it legally banned FGM in 1998, an estimated 15% of all girls and women between 15 and 49 years of age have undergone some form of FGM, almost always performed by a traditional practitioner. Incidence is highest among girls and women from rural and poor areas. Some hope, however, may be drawn from the fact that the girls in the youngest age group (15-19) are far less likely to have been cut than the women in the oldest groups. Something seems to be changing over generations. But as with most things, change takes time and community involvement. You at home can also play your part. Let me tell you how.

Mapping Matters

One way to combat FGM is by reaching out to communities and by going into dialogue with community leaders, parents and children. Educating them on the risks and long-term effects of FGM and informing girls at risk about ways to escape their tragic fate is key. For most parts of rural Tanzania however, maps are lacking, which makes it difficult for outreach workers to access and orientate in outskirt areas, and to reach the communities involved. Proper area maps which indicate roads and residential areas can help local NGOs (like Tanzania Development Trust) in their work and can help girls in finding a safe house (such as the one built in Mugumu). This way, maps can become an important tool in fighting FGM and this is exactly where you can come in.​​


Crowdmapping

You can help local NGOs worldwide to do their outreach work by joining the team of crowdmappers. All you need is a pc, a reliable internet connection, a bit of time and a few basic mapping skills you will easily obtain after going through the supplied instruction manual.

If you would like to map for Tanzania like I do, you first have to register as a United Nations Online Volunteer and enroll for the mapping project of Tanzania Development Trust. As soon as you have registered you will receive an email with all necessary information. They will ask you to open a free account at OpenStreetMap (OSM), a site for collaborative mapping. Then you are asked to go to the Task Manager for the Tanzania project which is hosted by the Humanitarian OpenStreetMap Team (HOT). To draw the maps, you will use the free online software, iD Editor. For this project on FGM in Tanzania, it basically suffices to trace highways and buildings and outline residential areas in the satellite images.


The idea behind HOT is to create and provide ‘Missing maps’. Missing Maps is a project that makes use of open source and open data and allows the crowd to collaborate in mapping for humanitarian organisations. Many vulnerable places in the world lack maps. When these areas are affected by some sort of humanitarian crisis (natural disasters, epidemics, human rights violations, environmental crises et cetera), maps can be a vital tool in the response of relief organisations. You can subscribe as a volunteer for different sorts of projects.


The availability of detailed basemaps can be crucial in midwifery care in many different ways. Geographic Information System (GIS) technology can provide us with important information on how to address high perinatal mortality and morbidity. Maps can be used to obtain a better insight into the location and distribution of maternal and neonatal health facilities in different regions, the available health personnel (among which midwives) and the travel distances for pregnant woman to reference centres. Underserved areas and obstacles linked to geographic distribution and availability can be traced. In case an emergency midwifery response is needed during disasters or outbreaks, geo-maps can be of incredible value.


For more on the possible application of mapping in midwifery, keep an eye on this blog. In the meanwhile, join the mapping midwives!


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Sources

Abdulcadir, J., Catania, L., Hindin, M.J., Say, L., Petignat, P. et al. (2016). Female Genital Mutilation: A Visual Reference and Learning Tool for Health Care Professionals. Obstetrics & Gynecology 128(5): 958-963. Doi: 10.1097/AOG.0000000000001686 See: http://journals.lww.com/greenjournal/Citation/2016/11000/Female_Genital_Mutilation__A_Visual_Reference_and.4.aspx

Ellison, M. & Lafrance, D. Safe House, Voices from the Cutting Season. A graphic Novel. See: http://marcellison.com/safehouse/en/#7

Humanitarian OpenStreetMap Team. See: https://hotosm.org/

Missing maps. See: http://www.missingmaps.org/

OpenStreetMap. See: www.openstreetmap.org

Sanghani, R. (2015). Meet the amazing woman running a safe house for girls fleeing FGM. See: http://www.telegraph.co.uk/women/womens-health/11509843/FGM-Meet-the-amazing-woman-saving-girls-in-Tanzania.html

Tanzanian Development Trust. See: http://www.tanzdevtrust.org/

UNICEF (2016). FGM/C Profiles by country, United Republic of Tanzania. See: http://data.unicef.org/resources/female-genital-mutilation-cutting-country-profiles/

United Nations Online Volunteer Programme. See: www.onlinevolunteering.org

World Health Organization (2008). Eliminating Female genital mutilation. An interagency statement. See http://apps.who.int/iris/bitstream/10665/43839/1/9789241596442_eng.pdf

World Health Organization. Health risks of female genital mutilation (FGM). See: http://www.who.int/reproductivehealth/topics/fgm/health_consequences_fgm/en/

A short video about the work of Tanzania Development Trust. See: https://www.youtube.com/watch?v=x1vxrZfLwCM

A testimony from one of the girls. See: https://www.youtube.com/watch?v=wEskE7R3XQk&feature=youtu.be

Photo Credits

Photo 1: CCBY Xudong Zhai, Sunset nearby Kijereshi Game Reserve 2014. See: https://flic.kr/p/p9bg2h

Photo 2: CCBY Jessica Lea/DFID, Janet rescued her 14-year old cousin Elizabet from FGM by fleeing to a safe house. See: https://flic.kr/p/PuVfHd

Photo 3: CCBY Blatant World

Photo 4: Screenshot OpenStreetMap.org

Photo 5: MidwifeWithoutBorders

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