Elena is 24 years old, and able to read and write. She is a slender, beautiful and cheerful woman, yet her life through adolescence and into womanhood has been marked by severe trauma.

Elena was about to complete Standard VII (the last year of primary school in Tanzania) when her father arranged for her to marry one of his friends. He gave her presents like money, soap, oil and slippers to encourage her to marry because his friend was an old man. When Elena tried to refuse these gifts, her father treated her very harshly.

The entire village soon learnt about the intention to marry off Elena, and when her school teacher found out, he beat her for wanting to marry and not staying in school. So Elena ran away to a sympathetic aunt.

In the many years that followed, she had marriage proposals from different men, before she began a relationship and fell in love with a young man named Nasibu. Her aunt knew Nasibu to be a good man, and Elena and Nasibu were married in 1999. Soon after, Elena conceived a child. She stayed with her aunt since it is customary in many cultures for a woman to stay with parents, close relatives or in-laws during a first pregnancy.

Her labor started in the afternoon when she was washing. The pain was strong, so she sent her cousin to bring her aunt from the fields. They returned after an hour, and told her to push whenever she felt pain. She pushed for the whole night.

Her husband came in the morning and found Elena very tired. He had no money to take her to the hospital, so Elena had to continue the delivery at home. At two in the afternoon, they called a traditional birth attendant (TBA).

The TBA came quickly and gave Elena an episiotomy using a razor. The TBA pulled the baby out, but it had already died. By now, Elena was unconscious and bleeding a great deal, so friends of her husband took her to the health center using a traditional bed tied between two bicycles. It usually takes 6 hours to get to the health center, but since it was night and raining, it took even longer.

When the medical officer examined Elena, he saw that she was leaking urine. Due to her prolonged and obstructed labor and the lack of access to proper emergency obstetric care, Elena almost died. In the end, the baby died, and Elena suffered a fistula.