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- The word on the street was
that if there were one place on earth that could treat Mohammad Lalu’s wife, it
would be the Koohi Goth Women’s Hospital in
The
50-year-old stone crusher hailing from the remote
Sitting upright on a plastic
sheet draped over one of the hospital beds, Bibi told IPS, “It took us two days
of non-stop travel to get here and we spent 12,000 rupees (roughly 120 dollars)
on the bus fare alone.”
It is a princely sum for a family of extremely modest means, in a country where the average income is less than 1,200 dollars a year. But for Lalu and his wife, the expenditure will be worth it if it can cure Bibi of her terrible affliction.
“Obstructed labour is especially common among young, physically immature women giving birth for the first time.” UN Population Fund (UNFPA)
While
virtually unheard of in the developed world, obstetric fistula is still common
in many Asian and African countries: the World Health Organisation (WHO)
estimates that it affects nearly three million women annually.
While country-specific data is
harder to find, local experts suggest that anywhere from 4,000 to 5,000 women
in
Caused by prolonged or
stressful labour, the condition arises when the baby’s head puts undue pressure
on the lining of the woman’s birth canal, eventually ripping through the wall
of the rectum or bladder and resulting in urinary or faecal incontinence.
Medial professionals say young
women, whose bodies have not yet matured enough to endure the birthing process,
are most vulnerable, as well as those who lack adequate nutrition or live too
far away from modern healthcare facilities.
Because fistula causes a woman
to lose control over her bodily functions, there is a huge stigma around the
condition. Those afflicted by it often smell bed, and are sequestered away from
their communities and families, forced to suffer in silence.
This is particularly traumatic
for young mothers, who end up spending the better parts of their lives having
little to no contact with the outside world.
Lalu told IPS that Bibi’s
trouble started soon after she delivered a stillborn baby boy when she was just
a teenager during her first marriage.
“I am her second husband,” he
said. “Her parents married her to me after her husband left her, but did not
disclose she was suffering from this dreadful problem.”
Unlike many other husbands,
Lalu did not turn away from his new wife; instead, he has gone to great lengths
to find her the necessary treatment. This hasn’t been easy, since fistula can
only be managed through reconstructive surgery, which is cost-prohibitive for
thousands of women.
Koohi Goth is one of 12 centres
set up under the United Nations Population Fund’s (UNFPA) Fistula Project that
offers the service for free.
Now in its eighth year, and
assisted by the Pakistan National Forum on Women’s Health (PNFWH), it has
trained 38 doctors to carry out the surgery. These numbers, experts say, pale
in comparison to the scale of
‘100 percent preventable’
According to the country’s
latest Demographic and Health Survey, 276 women out of every 100,000 die during
childbirth.
“All these deaths are 100
percent preventable if we can provide quality of care and stop child
marriages,” Dr. Sajjad Ahmed, head of the Fistula Project in
He believes that delaying the
age at which a woman experiences her first pregnancy would be a huge step
forward in preventing conditions like fistula.
According to the UNFPA, “For
both physiological and social reasons, mothers aged 15-19 are twice as likely
to die of childbirth than those in their 20s. Obstructed labour is especially
common among young, physically immature women giving birth for the first time.”
But changing the mindset that
sees nothing wrong with the idea of a child bride will not be easily
accomplished, especially in rural
Thirteen-year-old Shahbano,
hailing from the
Luckily, both Shahbano and her
baby son survived the ordeal, but she must now hope that her surgery goes well,
so she is not afflicted by incontinence for the rest of her life.
“In our culture, when a girl
first begins to menstruate, her parents are obliged to marry her off,”
Shahbano’s husband, Abid Hussain, told IPS.
Neither
he nor his teenage wife had any idea that the Sindh provincial assembly passed
the Child Marriage Restraint Act last month, prohibiting the marriage of
children under 18 years of age. Violation of the bill could earn offenders a
three-year prison term or a 450-dollar fine.
In 1929, the official marriage
age stood at 14 years, and in 1965 the law changed, making it illegal to marry
anyone under the age of 16. Today, Sindh is the only province to have
recognised 18 as the bare minimum age for marriage – a decision that has elicited
vehement opposition from religious groups.
Maulana Muhammad Khan Sherani,
chairman of the Council of Islamic Ideology, which acts as an unofficial
parliamentary advisor, said in reference to the amendment: “Some people want to
please the international community [by going] against Islamic teachings and
practices.”
“Such proclamations act as a
spanner in our fight against early marriage and early pregnancy,” Ahmed
asserted.
He says if he could give girls
like Shahbano one piece of advice it would be to educate their children,
especially their daughters.
“It will take a generation to
put things right, but education will automatically bring about a cultural
change, which could delay marriages. I see that as the only way to eradicate
this condition,” he stressed.
Currently, the country only has
the capacity to handle 2,000 cases of fistula, but doctors end up treating just
500 to 600 women a year.
Ahmed says this is largely due
to the fact that people do not know the condition is preventable or treatable,
and so avoid seeking out medical assistance. Many women live in rural areas
without access to televisions, radios or cell phones, making it hard to spread
awareness.
To circumvent the problem,
hospitals have mobilised ‘lady health workers’ – women who go door-to-door in
remote areas delivering information on sexual reproductive health and rights.
“We have a huge brigade of
almost 100,000 lady health workers,” Ahmed said. Although they cover just 60
percent of the country, they act as a bridge between rural populations and
urban-based care providers.
Perhaps these sustained efforts
will enable