March 9, 2006

Obstetric fistula is one of the most devastating pregnancy-related disabilities, which affects many women in South Asia, reports Rumaisa Aslam

There are times in life when many things are inexplicable and silence becomes the norm. But the greatest success of a person, nation and generation lies in turning all ears to the unspoken words.

In the underdeveloped countries, there are many women who have been going through mental and physical traumas. Amongst these traumas, obstetric fistula is the most devastating pregnancy-related disability which affects tens of thousands of women in South Asia.

It occurs when a woman has a prolonged, obstructed labour, coupled with lack of appropriate medical intervention, usually a Caesarean section to relieve it. She is left with chronic incontinence (constant leaking of urine or faeces) and in nearly all the cases the baby dies.

Fistula has serious social repercussions for the patients. They are often rejected by their husbands, shunned by the community and unrightfully blamed for their condition.

Recently UNFPA (United Nations Population Fund) launched a campaign to eradicate obstetric fistula from Pakistan by educating mid-wives and women about this crippling disability. The UNFPA has provided substantial assistance to many developing countries. With assistance from the government of Japan, the fistula initiative in Pakistan is supported through UNFPA in collaboration with the ministry of health and the implementing partner, the Pakistan National Forum on Women's Health.

The keynote speaker at the launch of the UNFPA backed programme was Dr Nafis Sadik, special envoy of the UN Secretary General on HIV/Aids in Asia, and former UNFPA Executive Director. Speaking on the occasion, she said, “The social consequences of fistula are disastrous for women. But a simple surgical repair which calls for no special technology or extensive expenditure can restore health, hope and a sense of dignity to women living with this devastating condition."

Apart from medical reasons, there are a series of social issues such as lack of public health workers and poverty which is the cause of chronic malnutrition. Fistula is a treatable condition, yet more than two million women remain untreated in the developing countries and 4,000 to 5,000 cases occur each year in Pakistan alone.

The first fistula centre was inaugurated in Dhaka, Bangladesh. The campaign launched in Pakistan aims to surgically repair and rehabilitate hundreds of women suffering from fistula by establishing four regional fistula treatment centres in Karachi, Multan, Islamabad and Peshawar. The amount allocated by the Pakistan government for this project is approximately Rs32 billion.

The government has come up with many strategies to train female health workers to provide guidance at doorsteps. Advocacy activities will also take place to raise awareness about the problem and efforts will be made to include fistula training in the curriculum of College of Physicians and Surgeons of Pakistan (CPSP).

In 2006, about 70 per cent of women in Pakistan will deliver their babies at home, a decrease of 10 per cent from 1998. A concerted effort has been made to lessen maternal mortality by allocating more resources to maternal health, including induction of a new cadre of community midwives and strengthening the emergency obstetrics care services in rural and semi urban areas. Data on fistula is limited. Dr Nafis Sadik gave these suggestions to control the disease:

*Delay the age of first pregnancy

*Provide access to family planning to help women plan and space births and improve access to pre-natal care for all pregnant women

*Provide skilled attendance at childbirth to help detect complications and refer women to hospital when necessary

*Provide affordable emergency care such as Caesarean sections when needed

*Collect data on the magnitude of the problem in Pakistan and in South Asia

*Disseminate information about prevention and treatment to health and social workers and to the general population i.e. women, husbands, mothers, and young people

Apart from Dr Nafis Sadik the other participants at the launching ceremony of the programme were, Dr Abdul Majeed, Federal Director General Health, Dr France Donnay, UNFPA Representative in Pakistan and Dr Sher Shah Syed, Associate Professor of Dow Medical University. The audience included leading healthcare providers from the public and private sectors, political and religious leaders and social activists.

Fistula should not happen at all in the 21st century. It has been eliminated in North America, Europe and Japan. Now it’s time for South Asian countries to bid goodbye to this devastating condition.

There is a need to ensure that every pregnancy is wanted, every birth is in safe hands and every girl and woman is treated with dignity and respect, and its prevention should be an important part of the Millennium Development Goals.

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