In northern Nigeria, a Hausa song entitled “Fitsari ‘Dan Duniya” echoes around a circle of women. Dr. Lewis Wall, a gynecologist and Professor of Sociocultural Anthropology at Washington University, loosely translated this as “Urine, The Oppressor of the World.”  The women sing to ease the pain of being deemed venereal disease carriers because they cannot control the trickle of urine. In reality, they suffer from vesicovaginal fistulas, a disorder resulting from obstructed labor; but in their culture, abnormal or restricted childbirth is punishment for sin and infidelity.

The Federal Ministry of Women’s Affairs concludes that these women are among about 800,000 Nigerian women suffering from vesicovaginal fistualas. They are among a much larger population of oppressed and suffering women that have not been educated about sexual and reproductive health.

Indian school girls Khushi and Ankita expressed fear to “New York Times” writer Rose George that they were dying of cancer when they begin menstruating. Their mothers told them that they were normal women now; however, they also told them not to touch food or religious idols because they would pollute and defile them.

Nadene Ghouri of BBC News visited  the largest maternity ward in Kabul, Afghanistan, where ignorance prevailed. A teenage girl, too embarrassed to be named, miscarried at five months. She didn’t even know she was pregnant because she was never told the symptoms of pregnancy.

This ignorance is not uncommon. This year, Chinese adults were interviewed by Newsweek about when they first learned about sex, and after much nervous giggling, one woman admitted she grew up thinking she came from her mother’s armpit. Although harmless jokes are told to children about their origin all over the world, they begin to pose a serious threat to society when parents object to any formal sex education in schools and the governments fail to implement a national sex education policy.

Li Zou, an employee of the Department of Social Work at Washington University, attended elementary and middle school in China and was also told myths about childbirth. “My parents told me that they found me out by the trashcans, but I saw the trashcans everyday and there were no babies. We didn’t know anything from formal education, but we were smart self-learners.”

Zou emphasized understanding the cultural sensitivity to the subject, and some of the consequences that ensue. “People just don’t talk about it. You’re considered a little crazy if you talk about sex, sex, sex. But there are always going to be those brave girls who want to experiment. The problem is, they want to be active, but they don’t want to have babies.”

A recent study by ­Tsinghua University in Beijing shows that 71 percent of young people in China are sexually active before marriage. Although these young people have no formal education, and only 12 percent of 1,000 Chinese women between the ages of 25 and 30 fully understand contraception according to a survey by “Newsweek” they are still adolescents persuaded by hormones.

“I used to swim with two girls, one a year older than me and the other a few months younger. They had both already undergone two abortions each, and one of the girls would suffer from fevers and physical pains. It was very hard to see her go through the process,” reflects Zou. “I know that people are always protesting outside Planned Parenthood in St. Louis, but that wouldn’t happen in China. To have the babies would be humiliating and shameful for the parents, the daughter, everyone.”

Although abortions are more controversial in the United States, many school districts aren’t teaching methods of contraception in classrooms. The Utah Legislature passed a bill mandating abstinence only sex education on March 6, 2012. The bill bans instruction in sexual intercourse, homosexuality, contraceptive methods and sexual activity outside of marriage.

Texas also implements an Abstinence Centered Education Program (AEP), and according to the website, it will “delay initiation of sexual activity as part of a continuum of services to decrease the teen pregnancy rate and rate of sexually transmitted infections (STIs) in youth ages 15 through 19.” As of 2012, Texas had the fourth highest teen birth rate of any state in United States.

Melissa Hobick, a health teacher at Clayton High School, feels that the best approach to sex education is being as realistic and open as possible. “This is the kind of thing that affects every single person. At some point people are going to have sex, and I want to make sure they know who they can come to.”

Although Hobick acknowledges the awkwardness surrounding the subject, she hasn’t encountered any restricting parental resistance. “I’m a part of lots of parent groups and councils, and about 95 percent of parents say thank you for teaching them so that they don’t have to.” Hobick proudly reports that in her nine years of teaching, only two students have opted out of the program for religious reasons. “I think we’re very fortunate. In other districts, they’re lucky if they get taught abstinence.”

Because of this good fortune, the thought of millions of humiliated and suffering women due to a lack of proper education can be hard to fathom. The task of coming up with a solution can be even more daunting.

Dr. Lewis Wall encourages understanding overarching ideas before setting out to find specific solutions. “By understanding local cultures better, one can be more effective in solving clinical problems. Ethics is really all about trying to figure out what the right thing to do is; it is about making you more sensitive to and aware of the issues involved.”

Wall encourages the empowerment of women as the key to the solutions.

“Advocate for women’s rights, support the education of women in countries around the world, and vote for candidates who will support women’s rights. The best way to look at it is simply to ask this question: ‘If I were a woman in this situation, how would I want to be treated.’”

For now, the circle of Nigerian women grows stronger as the beat of their anthem courses through their veins.  Khushi and Anikta ask to leave class in order to dispose of their pads in the new incinerator; for them, school has become bearable. Teenage girls in Afghanistan are given midwifery training, learning to move past the deaths of their babies and learning to save the lives of many more. In these women, who completely acknowledge the burden of their suffering, hope is born.