KARACHI: Emphasising the need for providing quality obstetric care in all parts of the country, especially in remote areas, health experts at a briefing stated that Pakistan yearly reported 3,000 to 5,000 cases of obstetric fistula, a devastating childbirth injury that leave women incontinent.

The event held on Saturday evening in connection with International Day to End Fistula was jointly organised by the Pakistan National Forum on Women’s Health in collaboration with Fistula Foundation, United Nations Population Fund, Pakistan Medical Association (PMA), Midwifery Association Pakistan and Tehrik-i-Niswan.

The key to solution, they pointed out, was to train and appoint competent midwives at each and every basic health unit and tehsil/taluka headquarters hospital.

Activist Sheema Kermani said the government should prioritise reproductive health, poverty and the issue of early marriage.

“An estimated 30,000 women die every year in Pakistan due to pregnancy-related complications while the majority of fistula cases involved poor teenage girls. There is a need to adopt a holistic approach towards maternal health,” she said.

“The actual number of cases could be much higher as the affected women often lose family’s support once they develop this condition. Such cases remain hidden and without diagnosis,” said senior gynaecologist Dr Shaheen Zafar, while underscoring the need for creating awareness so patients were identified and receive the much-needed treatment.

Explaining obstetric fistula, Dr Zafar said it’s one of the most serious childbirth injuries.

She said: “An estimated 2 million women in developing countries live with fistula, an abnormal opening between a woman’s genital tract and her urinary tract or rectum.

“The condition either caused urinary incontinence, faecal incontinence or both. The development of fistula is directly linked to one of the major causes of maternal mortality, that is, obstructed labour,” she said.

The condition, she said, was very much preventable, if pregnant women received timely quality medical care, and treatable through surgical intervention.

“The Koohi Goth Hospital in Landhi provided free-of-cost treatment and rehab services to fistula patients. Doctors also arrange camps across the country to indentify such cases. Right now, we have fistula centres in Karachi, Hyderabad, Larkana, Multan, Lahore, Quetta, Peshawar, Abbottabad and Islamabad,” said Dr Zafar.

Prof Nusrat Shah, Pro Vice Chancellor at the Dow University of Health Sciences, shared that while there had been some reduction in the number of obstetric fistula caused by untrained dais, there had been a rise in cases of surgical fistula for which doctors were responsible.

“These doctors either lack adequate training or are not supposed to take up the cases as gynaecology is not their field,” she said, adding that there were no checks on these surgeons involved in unethical practices.

Dr Sonia Naqvi, president of PMA-Karachi, called upon the government to utilise all its resources for the prevention of fistula. “The government should upgrade healthcare services, start midwifery training on a large-scale and provide midwives better service structure.”

She also spoke of the trauma women with fistula underwent as they were ostracised and rejected by their communities. “While it’s easy to treat a fistula, it’s difficult to repair the psychological scars that may remain for life,” she said.

Published in Dawn, May 23rd, 2022