Public awareness answer to obstetric fistula: experts

Islamabad: The International Day to End Obstetric Fistula was marked at the Pakistan Institute of Medical Sciences here on Wednesday with the experts declaring obstetric fistula a neglected women health and human rights challenge and calling for public awareness to effectively manage it.

Professor Nasira Tasnim, head of the PIMS MCH Unit-II and Fistula Project regional programme manager, told a function that obstetric fistula, one of the most serious childbirth injuries, was a hole in the birth canal caused by prolonged labour over the lack of timely and adequate medical care.

She said in most cases, the baby was either stillborn or died within first week of life and the mother suffered a devastating injury, a fistula, which rendered her incontinent. “Many women and girls with fistula are shunned by their families and communities and thus, deepening their poverty and magnifying their sufferings,” she said.

The Fistula Project manager said though the precise figures were not available, it was generally accepted that two to 3.5 million women suffer from obstetric fistula. She said the World Health Organisation put the number at 50,000-100,000 annually with the highest incidence being reported in sub-Saharan Africa and South Asia.

“In 2008, for the first time, the General Assembly acknowledged obstetric fistula as a major women health issue by adopting a resolution on ‘supporting efforts to eliminate obstetric fistula’. The resolution held poverty, malnutrition, inadequate or inaccessible healthcare, early childbearing, and child marriage responsible for obstetric fistula,” she said.

Professor Nasira Tasnim said massive public awareness was the answer to ‘this neglected women health and human rights challenge’. She said it was unconscionable that the poorest most vulnerable women and girls suffered needlessly from the devastating condition of obstetric fistula.

“These vulnerable women and girls are at the heart of the Fistula Foundation’s efforts to ensure that every pregnancy is wanted every child birth is safe and every young woman’s potential is fulfilled,” she said.

Another speaker, Dr Kausar T Bangash, regional coordinator at the PIMS Fistula Centre, said the victims of obstetric fistula were usually among the hardest to reach and were often illiterate and with limited access to health services including maternal and reproductive health care.

She said the persistence of the problem reflected broader health inequities and healthcare system weakness as well as wider challenges facing women and girls such as gender and socioeconomic inequality, lack of schooling, child marriage and early childbearing all of which impeded the well-being of women and girls, and their development opportunities. Dr Kausar said obstetric fistula had been virtually eliminated in industrialising nations as it was preventable and could mostly be surgically repaired.

She, however, said 3,000-5,000 new obstetric fistula cases were reported in Pakistan every year. “During the last eight years, the UNFPA has provided treatment to 5,000 women. Since 2016, the Fistula Foundation and Islamic Development Bank have directly supported more than 10,000 women and girls to receive surgical treatment for fistula through their eight regional centers in the country,” she said.

Athar Sayed, coordinator of the PIMS Fistula Project, said the ongoing anti-obstetric fistula campaign was based on three key strategies of prevention, treatment and social reintegration of the survivors.

She said the Pakistan National Forum on Women Health was executing the project across the country by offering surgical treatment, holding training programmes for doctors and mid-level healthcare providers, and raising awareness of social issues related to obstetric fistula.

“In Pakistan, a very high number of Iatrogenic fistula was recently reported. The Pakistan Medical Association and Society of Obstetricians and Gynaecologists of Pakistan have great concerns over this serious issue and demand health authorities to use their all resources to stop such practices. The PMDC and CPSP will have to redesign their policies for registration and trainings,” she said.

She said the PIMS Fistula Centre, one of the eight such countrywide facilities, had repaired more than 700 obstetric fistula patients from the catchment areas including four Punjab districts, including Jhelum, Chakwal, Rawalpindi and Attock, Azad Jammu and Kashmir, and Gilgit-Baltistan since April 2007 with 100 per cent success rate. “From vesico-vaginal to recto-vaginal to ureteric, all types of fistulas are repaired here.