Changing lives through obstetric repair surgery
Tackling obstetric fistula – which causes life-changing health problems for women – is a key feature of UNFPA Afghanistan’s work. UNFPA supported the Ministry of Public Health (MoPH) in establishing fistula centres in the provinces of Herat, Kabul and Nangarhar to provide services for obstetric fistula patients and help them get back to their normal lives.
Obstetric fistula is one of the most serious childbirth injuries. It is a hole between the birth canal and bladder or rectum caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It leaves women leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty.
UNFPA estimates indicate that more than 2 million women in Asia, sub-Saharan Africa, the Arab region, Latin America and the Caribbean are living with fistula, and that some 50,000 to 100,000 new cases develop annually. The persistence of fistula – an entirely preventable condition – is a sign of global inequality and shows that health systems are failing to protect the human rights of the poorest and most vulnerable women and girls.
25-year-old Shereen recently underwent fistula repair surgery. Her family migrated from Ghor to one of the remote villages in Chesht-e-Sharif, Herat province due to war and insecurity. Four months ago, when she first felt the labour pangs preceding the birth of her third child, there were no male members of her family to help transport her to a health facility – her husband was in one of neighbouring countries earning a living.
Home alone, Shereen struggled with pain for more than five hours, until her father and mother arrived to take her to the nearest village clinic. After many hours in labour, Shereen still had not given birth as the birth attendants at the clinic were not skilled enough to facilitate the difficult delivery of the child. The child – long dead – got stuck in Sheeren’s body. Her family rushed her to a clinic near the centre of Herat – it took them 10 hours to get there.
Health personnel in Herat couldn’t help her either, advising Shereen’s family to take her to a private hospital for caesarean delivery. Being a poor family, they couldn’t afford the expenses of a private hospital and chose to leave Shereen at the clinic. Yet more hours of intense labour pain and struggle followed before the birth attendants were able to deliver the baby. Tragically, the child was torn to pieces and Shereen’s bladder was damaged as a result of complications in delivery. When doctors saw her serious condition, they advised her family to seek treatment for her in Kabul but lacking money, they all went back to Chesht-e-Sharif.
Figures from the Fistula Foundation indicate that fewer than six in 10 women in developing countries give birth without the help of a trained professional such as a midwife or a doctor. When complications arise, as they do in approximately 15 percent of all births, there is no one available to treat the woman, leading to disabling injuries like fistula, and sometimes even death.
In Afghanistan, only 51 percent of births are delivered by a skilled provider according to the 2015 Demographic Health Survey, which also revealed that 56 percent of women with fistula did not seek treatment.
Shereen struggled with pain, exhaustion and social isolation as a result of obstetric fistula for four months. She had been to the medical centre in Herat on several occasions but doctors had been unable to help her, until her family managed to get ahold of some money for travelling expenses and an appointment at the fistula centre in Kabul.
After five days of travel, they arrived in Kabul – their final hope. Fortunately, doctors at the centre – the Malalay maternity hospital – conducted successful fistula repair surgery on Shereen. Thanks to MoPH and UNFPA, Shereen returned to Herat after three weeks, and has resumed normal life.