Stemming Fistula: Social Contraception In Pakistan


Eighteen-year-old
Razia Bibi was very pale and virtually blind after enduring the physical
and emotional pain of an 18-hour-long obstructed labour leading to the
birth of a stillborn baby. 

"When the baby’s head pressed against the lining of the birth canal
for many hours, it made holes in the walls of Bibi’s rectum and bladder.
These are called recto vesical fistulae. This condition makes her unable
to control her excretory functions," explained Shershah Syed, head
of the gynaecological ward at the government-owned Qatar General Hospital,
where Bibi had been brought for treatment. 

Her husband died in a road accident a few months earlier, and her father-in-law
and three older sisters have all washed their hands of her.

According to the UN Population Fund (UNFPA), which is leading a Campaign to End Fistula, nearly two million women – mostly in sub-Saharan
Africa and parts of South Asia – have the condition. 

Each year 100,000 new cases occur, according to the UNFPA Annual Report 2007, and of these an estimated 5,000 are in Pakistan,
according to the Campaign to End Fistula. 

Some experts say many cases go unreported. 

How to stem fistula? 

Specialists say fistula can be best avoided by stopping early marriages,
delaying the age of first pregnancy and by timely access to good emergency
obstetric care. They also say education is key.

Syed said: "Education and only education can get the Pakistani women
out of this mire. There is no magic pill that we can give to our expectant mothers.
And no amount of programs, projects or even foreign funds will
stop our women from dying unless our poor are armed with education.

"What we need is primary schools that can provide quality education,
not ghost schools on paper. It’s such a simple, workable formula which
would put many other things right in our society," he said.

Describing education as "social contraception," Sadia Chowdhury,
a senior reproductive and child health specialist at the World Bank,
said earlier: "Promoting girls’ and women’s education is just
as important in reducing birth rates in the long run as promoting contraception
and family planning." 

Syed, who examined Bibi, said the cause of her condition was early marriage.
"She is a mere child herself. Look how very tiny and pale she is.
She was not even ready for motherhood. With no one to take care of her,
going through so much trauma of losing loved ones… probably contributed
to complicating her pregnancy." 

UNFPA campaign 

Bibi’s operation cost about US$3,750 and will be paid for by UNFPA,
which launched its first-ever national campaign to end fistula in Pakistan
in 2006, putting up US$1 million over three years. This is part of its
global campaign in over 44 countries of Asia, Africa and the Arab region
in a bid to eradicate the injury. 

UNFPA is supporting efforts to surgically repair and rehabilitate fistula
sufferers at seven regional centres – Karachi, Islamabad, Multan, Quetta,
Larkana, Lahore and Peshawar – where surgery is carried out free of
charge. 

Of Pakistan’s 160 million people, 33 million are women of reproductive
age. Every 30 minutes a woman loses her life giving birth, said Sadiqua
Jafarey, president of the National Committee for Maternal and Neonatal
Health (NCMNH) and professor of Obstetrics and Gynaecology at Ziauddin
Medical University.  

This article was first published on IRIN News.

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  • invalid-0

    I think the idea that a woman of eighteen will physically mature in a few more years is strange. Most females reach full adult height by 13 to 15. If she is small stature or slight build at 18, that is probably normal for her. It doesn’t seem like 18 is particularly young. Her build may indeed have put her at risk. However, she is unlikely to grow out of it. Simply gaining weight won’t make the pelvis larger.

    I can’t see how better education will change a woman’s pelvis either.
    While we all want to see people have access to education, that won’t change the incidence of fistula. It may just mean the victims are a little older. They will still need treatment if they have a fistula when they are in their 20’s.

    Most victims may be teens because people in those countries marry early. But if there aren’t services for teens, are there services for women in their 20’s or 30’s?

    The real issue is getting women the care they need whether they are 18, 28, 38 or 48.

  • invalid-0

    I think the idea that a woman of eighteen will physically mature in a few more years is strange. Most females reach full adult height by 13 to 15. If she is small stature or slight build at 18, that is probably normal for her. It doesn’t seem like 18 is particularly young. Her build may indeed have put her at risk. However, she is unlikely to grow out of it. Simply gaining weight won’t make the pelvis larger.

    I can’t see how better education will change a woman’s pelvis either.
    While we all want to see people have access to education, that won’t change the incidence of fistula. It may just mean the victims are a little older. They will still need treatment if they have a fistula when they are in their 20’s.

    Most victims may be teens because people in those countries marry early. But if there aren’t services for teens, are there services for women in their 20’s or 30’s?

    The real issue is getting women the care they need whether they are 18, 28, 38 or 48.

  • invalid-0

    I think the idea that a woman of eighteen will physically mature in a few more years is strange. Most females reach full adult height by 13 to 15. If she is small stature or slight build at 18, that is probably normal for her. It doesn’t seem like 18 is particularly young. Her build may indeed have put her at risk. However, she is unlikely to grow out of it. Simply gaining weight won’t make the pelvis larger.

    I can’t see how better education will change a woman’s pelvis either.
    While we all want to see people have access to education, that won’t change the incidence of fistula. It may just mean the victims are a little older. They will still need treatment if they have a fistula when they are in their 20’s.

    Most victims may be teens because people in those countries marry early. But if there aren’t services for teens, are there services for women in their 20’s or 30’s?

    The real issue is getting women the care they need whether they are 18, 28, 38 or 48.

  • invalid-0

    Sorry for the multiple post.

    Not sure what happened.

    Perhaps the administrator can delete the extras.

  • invalid-0

    I agree, I don’t see what the reason is by giving birth at 18, this is a very common misconception when we’re talking about developing countries that are trying to mimic industrialized living styles in hopes that it would change the social fabric. I gave bith to my first child when I was 18, although I couldn’t give birth properly and had to have a caesarean, the same problem occurred when I had my second child at 20 and my third child at 22. How do you explain that? That meant that I myself is a genetic product where I cannot give birth properly (my grandaunt died of childbirth in the 1950s). I am five feet tall, ever since I was fourteen, my mother is smaller than me and yet she could give birth to four children, the problem lies in the body discrepancy between myself and my husband where his family has an average height of 5’5 for women and 5’7 to 6 for men. It is a very prejudiced and biased conception that such and such women are uneducated, please, I am offended, I finished my diploma at 17, and doing my degree in anthropology now at 23. If people are given the right to drink and smoke at 18, what’s the problem with giving birth?

  • invalid-0

    I totally agree. 18 is not that young and physical maturity should have been attained. There are girls being married much earlier, I think 8 is the youngest I have read about. Regardless women of all ages need healthcare and they need to stop being treated as if they are disposable.

  • wendy-banks

    More than likely the baby was large and hips were small. If she had had a emergency c-section, the baby might have survived and she wouldn’t have ripped her insides to bits trying to give birth. I didn’t see anywhere in the story about the size of the child or the lenght of her labor.

    My daughter was not large, but I still needed an episiotomy and forcepts. Of course if I had not be forced to lay flat on my back to labor– "Oh, no, you had an epidural, you can’t sit on the chair, crouch, or walk around, you’ll fall…" Twits. I wished my insurance had covered a nurse-midwife.