Obstetric Fistula – Another Risk for the Child Bride
Author: Womens UN Report Network
Date: April 16, 2012
WUNRN
Obstetric Fistula – Another
Blight on the Child Bride
By Zofeen Ebrahim
|
KARACHI,
Pakistan, Apr 13, 2012 (IPS) – It was personal experience that turned Gul Bano
and her cleric husband, Ahmed Khan, into ambassadors against early marriage and
its worst corollary – obstetric fistula which allows excretory matter to flow
out through the birth canal.
As is the
custom in the remote mountain village
of Kohadast in the Khuzdar district of Balochistan province, Bano was
married off as soon as she reached adolescence, at 15, and was pregnant the
following year.
There being
no healthcare facility near Kohadast, Bano did not receive antenatal care and
no one thought there would be complications. But, events were to prove
different.
After an
extended labour lasting three days, Bano delivered a dead baby. “I never
saw the colour of my son’s eyes or his hair. I never held him once to my bosom,”
recalls Bano, now 20.
Her troubles
had only begun. A week later, Bano realised she was always wet with urine and
reeking of faecal matter. “I was passing urine and stools together.”
Unable to
handle the prolonged labour, Bano’s young body had developed a fistula caused
by the baby’s head pressing hard against the lining of the birth canal and
tearing into the walls of her rectum and the bladder.
Bano’s
family attributed her condition to fate, her father refusing to visit “due
to the bad odour coming from me.” However, through those trying times,
Khan stood by his young wife and sought medical help.
After Bano
spent a year in a perpetually “wet and stinky” condition, her husband
finally discovered a hospital in Karachi specialising in treating fistula and other conditions
related to reproductive health.
Koohi Goth
Women’s Hospital, where fistula victims are treated free, was started by Dr.
Shershah Syed, one of Pakistan’s first gynaecologists to train in repairing a painful and
socially embarrassing condition.
In addition
to incontinence, the medical consequences of fistula include frequent bladder
infections, painful genital ulcerations, infertility and kidney failure.
In 2006, the
United Nations Population Fund (UNFPA) launched a four-year fistula repair
project as part of a programme to improve maternal health.
According to
UNFPA, at least two million women in the world live as Bano did – in shame and
misery. Most are not even aware that fistula can be repaired.
A major challenge
for healthcare professionals is that the number of women suffering from fistula
in the world is increasing by about 75,000 cases annually.
In Pakistan the true prevalence of fistula is unknown, but Syed
estimates that there are about 5,000 new cases every year.
With only
500 – 600 women undergoing corrective surgery annually, Pakistan needs to put more resources into addressing fistula –
which falls under the Millennium Development Goal (MDG) of reducing maternal
mortality by three-quarters by 2015.
The MDGs are
eight United Nations targets to be met by 2015 and, according to studies
published by the International Youth Council, a major civil society
organisation, Pakistan is unlikely to meet the fifth that deals with maternal
health.
Pakistan,
according to IYC figures released in 2010, has a maternal mortality rate (MMR)
of around 500 per 100,000 births that is sought to be reduced to three-quarters
from 1990-2015.
Pakistan’s maternal mortality ratio is wide-ranging, from 286 per
100,000 births in Karachi‘s urban areas to 756 in rural Balochistan, where child
marriages are compounded by non-existent health services.
“For
both physiological and social reasons, mothers aged 15-19 are twice as likely
to die of childbirth than those in their 20s,” says a UNFPA document.
“Obstructed labour is especially common among young, physically immature
women giving birth for the first time.”
Obstetric
fistula is now generally acknowledged to be another burden on the girl child,
deprived of basic education and forced into marriage – for which she is neither
physically nor mentally prepared.
Pakistan’s Child Marriages Restraint Act passed in 1929 permits
girls to be married at 16, but poverty, illiteracy and socio-cultural practices
result in girls being married off as soon as they reach puberty.
Syed’s team
continues to hold fistula repair camps in the remote areas of Pakistan that include training programmes for doctors and
paramedics in fistula management. “The complicated cases come to Koohi
Goth and simple repair is done in the field hospitals.”
The camps
provided an opportunity to reach out to affected women and their families and
encourage them to avail themselves of the free treatment in Karachi, where necessary.
Getting Bano
to Karachi was not easy. Khan gathered a group of able-bodied men who
took turns carrying her on a rope bed for three days just to reach a motorable
road.
“It’s
been almost three years and she has gone through six operations,” says Dr.
Sajjad Ahmed, who worked at Koohi Goth as manager of UNFPA’s fistula project
from June 2006 to February 2010. “She would not speak at all and she did
not understand Urdu.”
Today Bano
and Khan are regular visitors at Koohi Goth and vocal advocates of the campaign
against fistula. They travel across Pakistan, spreading the word about how to prevent the injury and
what to do about it.
“Khan
is a cleric and yet he does not conform to the stereotype of a religious
person,” said Syed. “He tells parents that fistula can be avoided if
they stop marrying off their daughters at a very early age.”
Bano shares
her story and tells married women about the importance of birth spacing,
antenatal checkups and timely access to emergency obstetric care.
Syed says Pakistan badly needs a mass awareness campaign on fistula
prevention and stresses the importance of social support for victims.
“That’s the only way we can eradicate fistula from this region.”
“I
smell nice now and it’s all because my husband wanted me to get well,”
said Bano, who may have spent many more years in a miserable state if not for
the treatment at Koohi Goth.
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