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The hardships of Pakistani women burdened with Obstetric Fistula

Global Fistula Map

What is Obstetric fistula?

It is a medical condition in which a hole develops in the birth canal as a result of childbirth which results in incontinence of urine or feces.

Complications may include

  • Depression
  • Infertility
  • Social isolation
  • Poverty

Risk factors include-

  • Obstructed labor
  • Poor access to medical care
  • Malnutrition
  • Teenage pregnancy.

Symptoms of obstetric fistula include:

  • Flatulence, urinary incontinence, or fecal incontinence, which may be continuous or only happen at night
  • Foul-smelling vaginal discharge
  • Repeated vaginal or urinary tract infections
  • Irritation or pain in the vagina or surrounding areas
  • Pain during sexual activity

How serious is Obstetric fistula in Pakistan?

Women in Pakistan ostracized because of obstetric fistula

Reports reveal that physical consequences of obstetric fistula is leading to a severe socio cultural stigmatization of Pakistani women. Since the majority of the population (60% as per Pakistani daily, The Nation) is uneducated they look at this medical condition as a divine punishment or a curse for disloyal or “sexual misconduct.

Pakistani women who are unable to produce children as “assets” for their families are facing severe ostracism. This is a big deal because achieving a sense of social belonging is a fundamental psychological need. This rejection further reduces self-esteem, sense of control, and a sense of having a meaningful existence for these women.

Liaquat University of Medical & Health Sciences (LUMHS) Obstetrics and Gynecology Department Chairperson Prof Dr. Roshan Ara Kazi reveals that over 5000 cases of obstetric fistula occur each year in Pakistan. She further adds, that most of these women are socially outcast-ed; they are not allowed to sit with the family, attend family gatherings and are thrown out of public transport while traveling. These patients are disliked by their husbands leading to marital disharmony and divorce. Because this condition is seen as that of shame and embarrassment, most women in Pakistan hide themselves and suffer in silence. Unfortunately divorce rates for women who are suffering from an obstetric fistula range from 50% to as high as 89% in Pakistan.

These marginalized members of society, are forced to live on the outskirts of their villages and towns, often living in isolation where usually die from starvation or an infection in the birth canal. The unavoidable odor is viewed as offensive, thus their removal from society is seen as essential. Accounts of women who suffer obstetric fistula proclaim that their lives have been reduced to the leaking of urine, feces, and blood because they are no longer capable or allowed to participate in traditional activities, including the duties of wife and mother. This forced upon loneliness and shame then leads to clinical depression and suicidal tendency. In certain cases, women have been forced to turn to commercial sex work as a means of survival because of the extreme poverty and social isolation.

Figures vary – 3500 patients reported by Agha Khan Hospital over 5000 patients reported by Koohi Goth hospital

Changing the regressive mindset of rural Pakistan will help prevent obstetric fistula

Medical professionals say, young women, whose bodies have not yet matured enough to endure the birthing process, as well as those who lack adequate nutrition or live too far away from modern healthcare facilities, are suffering from obstetric fistula.

But is changing the mindset that sees nothing wrong with the idea of a child bride is that easy?

In developing Muslim countries, women who are affected by obstetric fistula do not necessarily have full agency over their bodies or their households. Rather, their husbands and other male family members have control in determining the health care that the women receive. For example, a woman’s family may refuse medical examinations for the patient by male doctors, but female doctors may be unavailable, thus barring women from prenatal care. Furthermore, many societies believe that women are supposed to suffer in childbirth, thus are less inclined to support maternal health efforts.

It is a shame that we boast of our nuclear strength, but our women are still dying in labor,” said Dr. Sher Shah Syed who set up Koohi Goth hospital in Karachi, Pakistan’s only primary healthcare facility that offers treatment for fistula.

“Fistula is a poor person’s disease, and who cares about the poor in this country?”

No govt hospitals to treat obstetric fistula in Pakistan

Another local practitioner, Dr. Raza Murad hesitantly speaks up “In our culture, when a girl first begins to menstruate, her parents are obliged to marry her off. Nobody knows that the Sindh provincial assembly passed the Child Marriage Restraint Act, prohibiting the marriage of children under 18 years of age. Sheepishly he adds “In a lawless country like ours where politicians are busy bickering & looting taxpayers how can we expect decent medical facilities.”

Obstetric fistula a violation of Pakistani women’s fundamental rights to dignity and life

It goes uncontested and the medical lobby in Pakistan echo the same – The prevalent social, political, and economic situation in Pakistan has an indirect role in the increased cases of obstetric fistula in Pakistani rural women. Issues of poverty, malnutrition, lack of education, early marriage, childbirth, polygamy, harmful traditional practices (Female genital mutilation FGM), sexual violence, lack of good quality or accessible maternal and health care and limited awareness make Pakistan a perfect breeding ground for this physically & emotionally debilitating disease.

What happens in Pakistan?

In Pakistan, the act of FGM is practiced amongst select areas and communities – examples being the Bohra Muslims of Sindh & the Sheedi Muslim community of Pakistan . In recent years, due to a rise in strict sect religious compliance, the practice of FGM has increased. It is not just the young women of Pakistan but also British girls of Pakistani origin who are subjected to this procedure. Young British girls pack their bags with their favorite outfits, books, and toys and jump with joy at the thought of six weeks of holiday with their relatives. However, many young girls are unaware that their parents are taking them to Pakistan to carry out the FGM procedure.

According to the Institute of Social Justice in Pakistan, there are no laws to stop this practice. In fact, it is neither mentioned nor recognized by any law. The National Plan of Action for Children, which was introduced in 2006, finally included the goal of eradicating the practice by 2010. It is the only government document that mentions the issue. The implementation of the Plan, however, is another story. As a result, Pakistan has not reported the practice in its obligatory report to the UN Committee on the Rights of the Child, nor to the UN Convention on the Elimination of Discrimination against Women (CEDAW).

The Big Question is that who will take responsibility for such a serious medical condition haunting rural women in Pakistan? Unless laws to forbid such orthodox acts are put in place, the practice will remain firmly rooted in the people’s culture and will continue to be practiced. The failed state has once again failed its women – it cannot provide its young girls & women, security from social ills – honor killings, domestic abuse, forced sex, child pornography nor is it able to provide them with providing basic education and medical facilities. An absolute violation of Pakistani women’s fundamental rights to dignity and life. No questions raised why Pakistan is ranked 4th in the list of the most dangerous country for women in the worldsimply because there is no value for a women’s life in Pakistan.

19 Jun 2018/Tuesday.                                                       Written by Afsana

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