Both countries have a suspected high incidence of fistula, based on the low levels of skilled birth attendance and limited access to emergency obstetric care, widespread early marriage, high fertility, and restricted mobility for women.
Since last year, UNFPA, the United Nations Population Fund, has supported an effort to surgically repair and rehabilitate fistula sufferers at seven regional centres, working with the Ministry of Health and the Pakistan National Forum on Women's Health and supported by Japan's Human Security Trust Fund. Operating theatres and residences have been renovated, and surgeons and nurses have been trained.
On 27 April, Ms. Obaid and Health Minister Mohammed Nasir Khan formally opened the Islamabad centre - centres in Karachi, Quetta and Lahore opened earlier - and in two days surgeons operated on 12 patients.
Some 375 women have already received surgery at the regional centres, free of charge, and Dr. Mobashir Malik of UNFPA Pakistan expects twice that number to be treated in the next 12 months.
In Afghanistan on 25 April, Minister of Public Health Sayed Mohammed Amin Fatemi and the UNFPA Executive Director cut a ribbon at the entrance to the country's first fistula surgery ward, at Kabul's Malalai Maternity Hospital. Doctors are being trained at the Dhaka Medical College Hospital in Bangladesh and will begin treating patients in July. One hundred women are scheduled to receive surgery this year at the UNFPA-supported site.
Afghanistan has the world's second highest maternal mortality ratio - estimated at 1,600 deaths per 100,000 live births (or about 1 mother in 60) - for the same reasons that fistula is so prevalent. In Pakistan the figure is 553 deaths per 100,000 live births.
- William A. Ryan