Obstetric Fistula: an illness of social segregation

PESHAWAR: Obstetric Fistula is a serious disease that lands a woman in social segregation and it can only be treated through proper surgery.

Medical experts say that fistula is a serious injury of childbirth. It is a hole in the birth canal caused by prolonged, obstructed labour due to the lack of timely and adequate medical care. In most cases, the baby is either stillborn or dies within the first week after birth, and the woman suffers a devastating injury - a fistula that renders her incontinent.

According to the Fistula Project being run at the Lady Reading Hospital Peshawar, about 80 fistula patients are received every year and 75 have recovered to-date since 2015.The US-based Fistula Foundation states that the birth attendance by skilled staff in Pakistan is 49 percent. It also says that so far 21 fistula surgeries have been conducted through the Foundation’s funding in Pakistan.

 According to the statistics of World Health Organisation, each year 50,000 to 100 000 women worldwide are affected by obstetric fistula. It is directly linked to obstructed labour, which is one of the main causes of maternal mortality.

Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems. The WHO estimated that more than two million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.

The WHO noted that fistula is preventable and can be avoided by: delaying the age of first pregnancy, the cessation of harmful traditional practices, and timely access to obstetric care. The WHO declared that preventing and managing obstetric fistula contributes to the Millennium Development Goal 5 of improving maternal health.

Dr Nasreen Ruby, a gynaecologist and former head of the Gynae Department at Lady Reading Hospital, told this scribe that fistula sometimes remains untreated as it is considered a taboo in our society.

“I once treated a fistula patient who had been living with it for 35 long years and her surgery was successful. She was ashamed of even seeking treatment,” Dr Nasreen Ruby recalled. She pointed out that sometimes women are even divorced due to fistula as they cannot control their urination, become incontinent and cannot even pray.

“In our country, we see law and order problems and displacement of people due to militancy and military operations. In such circumstances, accessing medical facilities becomes difficult. And fistula is caused by delayed childbirth and mishandling of deliveries by untrained staff,” she added. Stressing that surgery is the only treatment of fistula, she said sometimes surgeries in severe fistula cases are unsuccessful.