Shaheena Mobin lies still in a bed in Karachi's Civil Hospital's surgical unit. Below her green hospital gown are two pint-sized bags on her stomach, collecting the waste her body is spewing. She looks no older than 10 or 11, yet the brave child opens her eyes and manages a weak smile — it is hard for the hospital staff to believe that this frail-looking girl had given birth just a few months back.
Dr Amjad Siraj Memon, professor of surgery, says she was brought to him from a village in Badin, after having suffered from a severe childbirth injury.
A mere child herself, Shaheena delivered a son who died within half an hour of being born, some nine or 10 months back. Her intestines were badly damaged after the delivery and since then, she was taken from one hospital to another until her parents decided to bring her to Karachi.
Considered fair game to be married at 11, her bone age X-ray shows her to be between 13 and 14 years. Yet her mother insists she is 18, without having a computerised national identity card (CNIC) to prove the claim.
In his over 27 years of practice, Dr Memon has come across many young mothers, even undernourished ones, but he says he has never seen a mother looking as young as this child.
"It's criminal what they did to her," he says, infuriated, as he pulls up the child's hospital gown to show two bags resting on her stomach — she has rectal as well as urinary incontinence and the two bags are collecting the waste.
Until only a couple of years ago, Shaheena had lived a carefree life like other girls in her village. She would play with her dolls, run barefoot, sometimes even bareheaded outside her home, on unpaved narrow alleys.
And then the inevitable happened, she got her period.
In her town, this is considered synonymous with getting married and her family hastened to find her a groom.
She was married off in a watta satta exchange, which is an arrangement under which a man marries a woman only if her brother/son marries a close family members of the man.
Shaheena says she didn't mind giving up her dolls in exchange for marriage which would mean getting new "makeup, clothes and jewellery".
Oblivious to her condition or what caused it, she unabashedly says her husband loves her and treats her well, as does her mother-in-law who shares household chores with her.
Women in the rural areas of Sindh are often pressured into bearing children soon after marriage, and with Shaeena it was no different. With little knowledge of reproductive health and parenting, she conceived very early in her marriage.
"If you marry off a girl at the age of 10, and she has a baby by 11 or 12, that is a child having a child; she is not ready. She doesn’t even understand what it is; physically, emotionally and psychologically she is not ready," said Professor Babatunde Oshotimehin, Executive Director United Nations Population Fund (UNFPA), recently at the News Agency of Nigeria (NAN) Forum in Abuja.
He may well have been talking about scores of Shaheenas that meet this fate every day in Pakistan.
"We must redouble our efforts to stop this trend," says Dr Farid Midhet, heading Jhpiego, an international consulting firm and an affiliate of the Johns Hopkins University, in Baltimore, which is carrying out a USAID-funded Maternal and Child Health Integrated Programme in Pakistan.
"Early marriage snatches away their childhood and youth, opportunities of education and playing a role in the community, and their dignity,” adds Dr Farid.
Complications during pregnancy and childbirth are a leading cause of death in young women aged 15 to 19, he says.
Yet calls like these made by scores of health practitioners largely fall on deaf ears.
Shaheena has outlived her stay and is going to leave the hospital soon, carrying the fecal and urinary bag which would be with her for the next couple of years when Dr Memon will perform a colostomy on her. A colostomy is an opening — called a stoma — that connects the colon to the surface of the abdomen. This provides a new path for waste material and gas to leave the body.
"Just look at her," he says, pointing at the child. "She barely made it alive. She's undernourished and needs to get her strength back otherwise she will not be able to bear another surgical procedure.”
But her mother, Manna, insists her daughter is "old enough". She says it is common in their village for girls to get married once they reached puberty.
"Girls as young as my daughter give birth all the time; it is nothing unusual. Shaheena was just unlucky," she assures, saying "as soon as she gains strength, she can try for another baby."
Unlettered Manna has no idea about the passage of the new Sindh Child Marriage Restraint Act 2013, which has raised the legal age for marriage in Sindh province to 18. She also does not know that those flouting the law will face imprisonment which may extend to three years and a fine.
She also seems undeterred now that she knows that the law exists.
"It is a private matter and even if the maulvi refuses, we know how to appease him," she says with determination in her eyes.