KABUL, Afghanistan – “I saw myself as the living dead,” 50-year-old Laila* told UNFPA. She suffered terribly while giving birth in Pakistan 27 years ago. The prolonged, obstructed labour left her with an obstetric fistula – one of the most serious injuries that can occur during childbirth.
The fistula – hole between the birth canal and bladder or rectum – can cause pain and chronic infections. It also causes incontinence, which often leads to women’s social isolation.
Yet the injury has been eliminated in much of the world through modern emergency obstetric care. Those who continue to suffer from obstetric fistula tend to be among the most marginalized and vulnerable.
“At the beginning, I was ashamed to tell anyone that I had fistula. Most of the time, I could not take part in social gatherings because I smelled bad,” Laila recounted.
As can be the case for fistula survivors, Laila lived with the injury for decades.
A new life
According to a 2015 survey, approximately 3 per cent of ever-married Afghan women have experienced obstetric fistula. Contributing to this high prevalence are the country’s high rates of child marriage and adolescent birth – early childbearing increases the risk of complications.
Poor access to health services also plays a key role. Only 51 per cent of births in Afghanistan take place with the help of a skilled birth attendant.
But there is help.
Years ago, Laila moved from Pakistan to Paghman Province in Afghanistan. Then one day she learned about the Malalai Maternity Hospital in Kabul, where surgical fistula repair is available.
Afghanistan’s only expert fistula repair surgeon works at the Malalai centre, along with four additional surgeons who provide basic fistula operations.
The treatment was a success, she says. “The operation has given me a new life," she said.
“Live a normal life”
Twenty-year-old Farah* also suffered a prolonged labour during childbirth at her home in Afghanistan’s Faryab Province six months ago.
“My life became very hard. I could not talk to anyone about my condition because of shame,” she recounted to UNFPA. “It made my life completely unbearable.”
The injury caused pain and bleeding, as well.
“I could not work, sleep or walk as I did before. I was not able to go out because of bleeding. I was not able to sit on the ground, on chairs or on carpets because of my illness.”
She isolated herself. “I could not gather with my relatives and family members because of my bad smell. I was fed up of my life. I should have been working in the home with cooking, cleaning and doing laundry as a housewife but was not able to do any of that properly. I felt incapable and useless in society.”
Fortunately, her family stood by her.
“They knew that I had fistula but they never changed their behaviour towards me. They never left me to suffer alone,” she said.
Not long ago, one family member learned about the Malalai fistula centre and helped Farah get treatment.
“I am happy, healthy and hopeful again after the operation,” she said. “I am a capable member of society once more and can start over with my child, husband and family members and live a normal life.”
UNFPA helped to establish the Malalai fistula treatment centre in 2007, and continues to provide support to its operations. UNFPA covers the cost of treatment, medication and transport for patients, and supports training for the hospital’s expert fistula surgeon.
There are also four additional surgeons providing fistula repair in two other provinces, Herat and Jalalabad. Since 2010, more than 600 surgical fistula repairs have taken place in collaboration with the Afghan Ministry of Public health, including 45 this year.
Still, across the country there is a major shortage of surgeons able to perform these operations. In addition, rehabilitation and reintegration programmes – which can help survivors overcome social isolation – are not available.
Farah wants to help other women avoid her ordeal.
“I would like to encourage every woman suffering from obstetric fistula to seek help without any concern and shame,” she said. “I also want to tell them to be careful not to go through childbirth without a skilled birth attendant to assist during delivery.”
*Names changed for privacy reasons