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END FISTULA

Let's demand a world without the
traumatic childbirth injury

TAKE THE INTERACTIVE QUIZ TAKE THE INTERACTIVE QUIZ

Obstetric
fistula
happens
when
the
baby
becomes
stuck
inside
a
woman’s
body
during
childbirth.



This
results
in
a
devastating
injury
-
a
hole
forms
between
the
birth
canal
and
bladder
and/or
rectum
resulting
in
uncontrollable
leaking
of
urine
and
faeces.



Fistula
deeply
affects
a
woman’s
life;
It
causes
horrific,
life-altering
damage
to
the
woman’s
body



...and
brings
with
it
shame,
deepening
poverty
and
social
rejection.



LEARN MORE ABOUT FISTULA LEARN MORE ABOUT FISTULA
90%

of
pregnancies
in
which
the
woman
develops
fistula
result
in
stillbirth
Source:
Lancet
Glob
Health.
2016;
4:
e80-e82



share the stat

My bed was wet after I got up every morning...I lived for 49 years like this”.
Noorjahan, Afghanistan

"My grandchildren will play with me. I am clean. I can practice my faith. I can
live."

Kabul, Afghanistan  -  Within the gates of Malalai hospital hundreds of women,
children and anxious men sit in the few sunny areas of the courtyard, bouncing
sick babies on their laps, waiting. Inside the female-staffed maternity
hospital, the halls resonate with the moans of women in labor while they share
beds in crowded rooms humid with the stress of new birth.

Further down a maze of hallways, hidden at the end, is a silent space where
seven women sleep under heavy blankets. Exhausted and worn as if ending months
of weary travel, these women are recovering from fistula surgery, and more
importantly, from years of exclusion from society. Because of the constant smell
of urine that caused them heartbreak and shame, they were shunned from everyday
life, unseen in daily life, and abandoned by their husbands.

Obstetric fistula is a devastating injury acquired during prolonged or
obstructed labor without timely access to emergency obstetric care, resulting in
a hole between the vagina and bladder or rectum, which leaves women leaking
urine or feces. The fistula ward in the Malalai Maternity Hospital, supported by
UNFPA, the United Nations Population Fund and Afghanistan’s Ministry of Public
Health, is one of few places in Afghanistan women can receive free emergency
obstetric care and surgeries by trained female surgeons.

Fistula surgery is the solution to a problem that often seems unapproachable in
Afghanistan. In some ways, women with fistula issues are considered the lucky
ones, surviving the high maternal mortality rate that haunts Afghanistan; though
none of them would think of themselves as lucky. A lack of maternal care and
education, malnutrition, child marriage, remote villages on rarely traveled
roads, society’s powerless role for women, not to mention ever-raging war, all
stack up against women who suffer this problem. 

Noorjahan, 67, lived with fistula for 49 years until her recent surgery. During
those years she hid in one room, rarely leaving, sewing to make a living. Every
morning, afternoon and evening she cleaned her soaked mattress and searched for
plastic bags that she tied around her like diapers.

To find the fistula ward, Noorjahan traveled from far away to reach Kabul, a
difficult task for an illiterate woman with obstetric fistula, hanging on a
rumor she had heard about the existence of doctors who could help her. For four
days she wandered the streets of Kabul before finally finding Malalai Maternity
Hospital and the fistula ward inside.



Now, days after surgery, Noorjahan smiles.

“I can die now. My grandchildren will play with me. I am clean. I can practice
my faith. I can live,” she says with a laugh that ends only because of the pain
leftover from surgery.

While she drinks tea, delicately rearranging herself in her bed, she is visited
by former patients who now are attempting normal lives and have returned to the
ward for a check-up. They interact like war veterans, understanding the torment
of their lives without having to speak of it, checking in with each other in the
recovery room, and sharing each other’s silent tears after nightmares about the
life before.

One such fistula veteran is Guldesta. She married at the age of 12 and had a son
at 13 in the distant region of Pul-e Khumri. She had two daughters, then several
miscarriages that led to an obstetric fistula. She lived with the injury for
many years until her surgery at Malalai Hospital.

“People have told me not to take my daughter or daughter in law to a hospital
when she is about to give birth, but I have never listened to them. I have seen
so many problems and difficulties of fistula. I wasn’t able to sit a minute with
my guests because I had a bad condition. I was sitting alone for days and
nights,” she said.

Now, she is a mother-in-law with a grandchild.

Guldesta’s is a rarity in her community. Living in a three-room home without
running water that she shares with over 15 people, she lives in a community
where poverty is rampant and education is scarce. But through her own
experiences with fistula and the doctors who helped her, she has made it her
duty to educate others, starting with her own family.

“My daughter is too young to marry now, but I will see what the future brings
us. My older daughter is married to a man in Jabulsaraj (a district in Parwan)
and there are not many hospitals around. She is here now and I will take her to
Malalai Hospital whenever she is about to give birth.”

Doctors who work with UNFPA and the Ministry of Public Health say that lack of
education is at the center of the problem. Compared to the amount of women who
suffer from an obstetric fistula in Afghanistan, very few have actually made it
to Malalai Hospital for care.

UNFPA attempts to address the issue by supporting training of female midwives
and doctors who can help women with preventing and recovering from this injury
as well as educating men and women on the problems of child marriage.

“Women wouldn’t be allowed to come to the hospital if there were male doctors,”
says Dr. Nazifa Hamrah, 51, a fistula surgeon. “All of my colleagues are women,
so we are very comfortable and can focus on our work.”

The training of midwives to work is central to preventing fistula. UNFPA
supports training of midwives who are selected from their rural communities
through a process involving families, shuras and elders to make it a community
decision to educate women as midwives, showing its importance to all involved.
The process also ensures that future midwives return to serve the community once
they have completed their education in the Family Health Houses that the
community have built.

In these regions finding girls who have completed a 10th grade education is
often difficult. An 8th grade education is required. But, through training,
these midwives have become the heroes to women in their region, one doctor said.

Sina Alizada, 41, trained as a midwife in the mountains of Bamiyan. House calls
were made by horse, the roads too treacherous for cars or motorcycles.

There are many issues related to fistula problems in Afghanistan that need more
attention, explained UNFPA Representative, Bannet Ndyanabangi. “The isolation
and stigma of the recovering women is not over even after medical treatment. The
survivors need help to start making a living and for reintegration into their
communities for a life of dignity and hope.”

- Andrea Bruce

READ HER STORY READ HER STORY
8%

Obstructed
labour
is
one
of
the
leading
causes
of
maternal
death
worldwide
and
accounts
for
an
estimated
8%
of
maternal
deaths
Source:
Ann
Med
Health
Sci
Res.
2015;5(1):20–5.



share the stat

No woman deserves to live in misery, especially when fistula is treatable”
Razia, Pakistan

“Never give up hope,” fistula survivor tells Pakistani women

ISLAMABAD, Pakistan – “Helping women suffering fistula is my mission in life,"
Razia Shamshad said about the maternal injury from childbirth that she thought
would ruin her life. “No woman deserves to live in misery, especially when it is
treatable.”

Ms. Shamshad, 29, was born in a small village in southern Punjab. Her family did
not want her to go to school, so she had only received an informal religious
education by age 13, when she was married off. Ms. Shamshad was already
expecting her first baby within a few weeks of her wedding. Then, when she was
six months pregnant, her husband died in a road accident.

Unable to afford proper medical care, Ms. Shamshad was assisted by an unskilled
traditional birth attendant who was unable to manage complications. When Ms.
Shamshad suffered an obstructed labour, the birth attendant did not summon
medical help. Ms. Shamshad was in agony for four days, an ordeal that could have
killed her.

In the end, her daughter was stillborn, and Ms. Shamshad suffered serious
damage. She developed an obstetric fistula, a hole in the birth canal. Fistula
leaves women leaking urine, faeces or both, and often leads to chronic medical
problems.

The condition is preventable with timely access to quality medical care, such as
Caesarean section. Tragically, it persists among the most marginalized women,
with pregnant adolescents and undernourished women facing particularly high
risks. And its sufferers are further marginalized, often facing ostracism and
discrimination. 

The Koohi Goth Women’s Hospital performs fistula repair surgeries for
free since 1992. © UNFPA Pakistan

"People would either avoid me or just make fun of me," she said. "I never felt
clean."


A STROKE OF GOOD LUCK

But Ms. Shamshad was able to put her life back together. Her relatives learned
about free treatment available at the Koohi Goth Women’s Hospital, which
specializes in treating fistula and other conditions related to reproductive
health. Two years after her ordeal, her family paid for her to travel to Karachi
for care. 

Ms. Shamshad’s condition was complex, and required multiple surgeries between
2010 to 2016. Even so, she has been able to regain her life. 

“Her determination was exceptional. She was resilient and strong and was able to
pull through the difficult process successfully,” said Dr. Sajjad Ahmed, who was
trained by UNFPA to perform fistula repair surgeries.

Ms. Shamshad went on to meet her current husband. They adopted a little girl.
And though she was not expected to be able to get pregnant again, she surprised
everyone by conceiving. With regular prenatal care and a C-section, she had a
healthy baby girl.


COMBATING FISTULA SINCE 2003

In many ways, Ms. Shamshad was lucky. The story is very different for many
fistula survivors in Pakistan, who are unaware that there is treatment
available.

And many more women and girls are at risk.  Access to reproductive health
services remains a challenge for women in Pakistan. Only an estimated 52 per
cent of women give birth with the help of a skilled attendant, leaving them
vulnerable to complications like prolonged, obstructed labour.

Ms. Shamshad lives with her family in Karachi. © UNFPA Pakistan

In partnership with the Pakistan National Forum on Women's Health, UNFPA has
established treatment centres for fistula patients across the country. UNFPA
also supports campaigns to raise awareness about the importance of skilled
obstetric care and ending the stigmatization of women with fistula.

UNFPA leads the global Campaign to End Fistula. Since 2003, UNFPA has helped
perform over 105,000 surgical fistula repairs in more than 55 countries in
Africa, Asia, the Middle East and Latin America.


“MY EXPERIENCE HAS GIVEN ME THE COURAGE TO HELP WOMEN WHO HAVE LOST ALL HOPE”

Today, Ms. Shamshad lives with her family in Karachi. She volunteers at the same
hospital where she received the treatment that turned her life around.  Ms.
Shamshad helps new patients recover after their own treatment.

“I believe life experiences shape us into the people we need to become," she
told UNFPA. "My experiences have given me the courage and drive to help women
who have lost all hope because of fistula.” 

Ms. Shamshad recently represented the hospital at the Nairobi Summit on ICPD25
in November 2019. She used her story to inform and motivate other women, to whom
she has proven to be a source of encouragement.

"Never give up hope," she told them.

READ HER STORY READ HER STORY
500K

women
and
girls
are
estimated
to
be
living
with
fistula
globally.
Source:
Intensifying
efforts
to
end
obstetric
fistula
within
a
decade:
2020
UN
Secretary
General’s
report.



share the stat

"I was discriminated against. I was humiliated. People talked. Because of the
looks, I stayed there shrunken.” Beatriz from Mozambique.

In Mozambique, an obstetric fistula survivor's journey from "I was nothing" to
"I am capable of everything"

MOCUBA, ZAMBEZIA PROVINCE, Mozambique – Beatriz Sebastião suffered in silence.
She had no friends in the neighborhood or at school. When she went to church,
she sat alone. When she went to the river, other women mocked her before leaving
to bathe elsewhere. 

She had become pregnant at 15 and because she lived far from the hospital,
planned to give birth at home. After three days of labour, her parents had to
raise money to rent a motorcycle to take her to the hospital, where she
delivered a stillborn child. She developed an obstetric fistula, and when she
became pregnant again, that child, too, was stillborn. But the fistula caused
urine to leak, and the resulting smell isolated her from nearly everyone for the
next six years. 

A treatable, preventable condition

Obstetric fistula is a hole between the birth canal and bladder or rectum, which
can cause incontinence, leading to social ostracization and attendant
psychological issues like depression. The treatable and largely preventable
condition is the result of prolonged, obstructed labour with no access to
skilled care, often resulting in stillbirth. Girls whose bodies are too young to
deliver a baby are particularly vulnerable. 

Every year, there are an estimated 2,500 reported fistula cases in Mozambique,
of the 50,000 to 100,000 cases globally. Since 2018, in partnership with the
Government of Mozambique, UNFPA has supported the repair of more than 2,300
fistulas, recruited 28 fistula surgeons, expanded a real-time monitoring system
of cases to 25 health facilities, and educated thousands of people about the
causes and consequences of the condition. 

A life transformed

Ms. Sebastião, now 28, had once sung gospel and six years after developing the
fistula, received a fateful invitation to perform at a youth meeting. Encouraged
by an uncle, she went, “but as always, I was discriminated against. I was
humiliated. People talked. Because of the looks, I stayed there shrunken.” She
stayed alone in a tent because no one would share space with her. 

Ms. Sebastião’s husband, Barcilai Artur (here in their living room), stood by
her when many women with obstetric fistula are abandoned. © UNFPA Mozambique

Then the youth coordinator, who also worked at a hospital, sought her out when
she skipped practice, claiming illness. Finally, she admitted she had “a disease
that made me pee involuntarily,” which is when she learned that what she had
could be cured through surgery. 

Ms. Sebastião was one of the rare fistula survivors whose family and husband did
not abandon her. With their support, she had the operation and, for the first
time in years, awoke without having wet the bed. “I don’t know how to express
what was in my heart,” she recalled. “I had emotions I don’t know how to
describe.” 

She was no longer the person others fled from. She could wear skirts again,
instead of covering herself with multiple layers of cloth. She started a small
grocery business, something unthinkable before, and became an activist, holding
chats with women in various communities to discuss fistula. She learned “to love
that Beatriz from the past again,” she said. “When I had the disease, I was
nothing. Now, I am capable of everything, able to fight for my well-being and
raise my self-esteem.”

 

The contagious joy of a woman with a repaired fistula

Albertina Luis is a radio journalist and activist in Mocuba District. When her
activism focused on domestic violence, she would meet women hiding behind their
houses or in the cassava trees – not from abusive husbands but because they had
obstetric fistulas. Ms. Luis underwent reproductive sexual health training and
learned more.  

Activist and radio journalist Albertina Luis educates women on the prevention
and treatment of obstetric fistula through her broadcasts in Mocuba District. ©
UNFPA Mozambique

Now, through regular broadcasts, she reduces shame and stigma surrounding
obstetric fistula and lets women know how to prevent it, including avoiding
forced, premature marriage and unintended pregnancy, and where to seek medical
treatment. “Dignity means being valued,” Ms. Luis, 50, said. “The greatest
wealth is health. In addition to being a right, it is power. I am freeing women
who have lost their dignity for a long time.” 

Dr. Armando Rafael, a fistula surgeon at Mocuba Rural Hospital, who operated on
Ms. Sebastião, finds his work rewarding, knowing the suffering and
marginalization patients have endured. “The contagious joy of a woman when her
fistula is repaired is incomparable,” he said. 

During Ms. Sebastião’s long exile, women at the river taunted her with the cruel
nickname “Lake Bethesda,” a reference to the Bible's Pool of Bethesda that never
ran dry. For her, the name takes on a different significance now: in Biblical
lore, the pool was a place where miracles happened and people were healed.

 

READ HER STORY READ HER STORY

When
a
woman
develops
an
obstetric
fistula,
the
baby
almost
always
dies.




SAMIRA'S
STORY

If you were a teenager living in a remote hilly district, would you be able to
make the choices needed to avoid developing a fistula? Step into Samira’s world
to find out.

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BE A PART OF THE SOLUTION

FIND
OUT
HOW
YOU
CAN
ACTIVELY
HELP
WITH
PREVENTION
OR
HELP
THOSE
WHO
ARE
SUFFERING

ABOUT THE CAMPAIGN ABOUT THE CAMPAIGN

Learn how to get involved in the campaign

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