THE World Fistula Day, which falls today (May 23), is an occasion to highlight obstetric fistula — one of the most devastating but preventable complications of childbirth. Obstetric fistula usually occurs after prolonged obstructed labour when a woman fails to receive timely medical treatment, particularly emergency obstetric care, such as a caesarean section.

Continuous pressure during labour damages the tissues between the birth canal and the bladder or rectum, leading to involuntary leakage of urine or faeces. Beyond physical suffering, affected women often face social isolation, stigma and psychological trauma.

Every year, an estimated 4,000 to 5,000 women develop obstetric fistulas during childbirth in Pakistan. Many women cannot reach hospitals in time because of long distances, lack of transport and the non-availability of free ambulance services. Home deliveries conducted without skilled birth attendants further increase the risk.

Only a few hundred women receive treatment each year because of the scarcity of trained fistula surgeons. The Sindh Institute of Urology and Transplantation (SIUT) is one of the few centres providing free treatment with dignity through minimally invasive techniques. So far, more than a thousand fistula surgeries have been performed. In 2025 alone, 39 such surgeries were carried out, including nine robotic vesicovaginal fistula repairs. The institute is running a dedicated fistula clinic every Friday.

Obstetric fistula can largely be prevented through improved maternal healthcare services, timely emergency obstetric care, skilled birth attendants, rural maternity facilities and free ambulance services. Repair surgery can successfully restore dignity and hope to the affected women. Preventing obstetric fistula is not merely a medical issue; it is a matter of women’s rights, social justice and human dignity.

Dr Murli Lal
Karachi

Published in Dawn, May 23rd, 2026