KARACHI: As countries across the world today renew their commitment towards maternal health on the International Day to End Obstetric Fistula, there is hardly any voice for the rights of women who face social ostracism in Pakistan due to lack of proper healthcare facilities.

One such woman is 35-year-old Rukh­sana, a villager hailing from Kha­ran district of Balochistan, who neither received proper healthcare during her delivery nor at the time when she developed fistula.

An obstetric fistula is described as a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labour, leaving a woman incontinent.

Currently recovering after undergoing surgery at Koohi Goth General Hospital in Landhi, the mother of two had suffered from incontinence for five years. “I endured a lot of abuse at the hands of my in-laws and husband who finally left me … often insulting me that I am of no use to him,” she said while speaking to Dawn.

Helped by her brothers and sisters, Rukhsana was twice operated upon for fistula, once in Quetta and then in Karachi at a private hospital. But both operations were unsuccessful.

“My tragedy started when I had a stillbirth in 2013 [which resulted in fistula]. My family had to sell off some belongings and borrow money to get me treated at Quetta and later in Karachi,” she said, adding that she came to Koohi Goth hospital after someone told her that she should see a fistula expert there.

The hospital is a major facility for fistula treatment in the country. Over the past two weeks, 15 women have been operated at the hospital, which receives 450 to 500 fistula patients annually.

Interviews with fistula patients at the hospital not only provided a peak into the healthcare challenges the country faces but also reflected on the status of women in society and the long journey they still need to take for a dignified life within their communities.

Sardaran, a 30-year-old resident of Jacobabad, developed fistula when she had a caesarean section for her 11th child six months ago. Even at this stage, she finds it hard to guess what made her newborn baby so malnourished.

While talking to Dawn, she said: “My parents married me off [early]. I have done the same with my two daughters.”

Around two million women in sub-Saharan Africa, Asia, the Arab region, Latin America and the Caribbean are living with obstetric fistula, with 50,000 to 100,000 new cases recorded annually, according to experts. In Pakistan, every year witnesses around 5,000 new fistula patients.

“It is preventable if women have timely access to quality healthcare. Its persistence is a sign that health systems are failing to meet women’s essential needs,” said Dr Shershah Syed at the Koohi Goth Hospital.

He said the condition left women incontinent and, consequently, they were often rejected by society.

Also a petitioner in a case seeking government support for fistula patients, Dr Shah said there was little progress in the case that reflected official apathy. Obstetric fistula, he said, was the manifestation of a society struggling with issues like lack of education, violence against women and early marriages.

It also highlighted the great need for making quality midwifery services available to women, he added.

In this situation, the United Nations Population Fund (UNFPA), which had been funding the initiatives for fistula treatment since 2005, withdrew its support last year.

Under the agreement it had with the government, the latter was supposed to take over the facilities developed by the foreign donor organisation after five years. But that didn’t happen.

“It’s unfortunate; the UNFPA which is funding fistula programmes in 52 countries has completely withdrawn its assistance in Pakistan, while no further commitment has been made by the government,” said Dr Sajjad Ahmed Siddiqi of the Pakistan National Forum on Women’s Health.

“It’s a matter of satisfaction, however, that the doctors working at five out of 13 centres in the country have managed to continue their services with private donations in the absence of UNFPA support.

“Presently, all fistula centres are operational, now with the assistance of the Fistula Foundation of Nigeria, which has committed to support fistula centres for a year,” he added.

Published in Dawn, May 23rd, 2017