Stemming Fistula: Social Contraception In Pakistan

Zofeen T. Ebrahim

Pakistani specialists say fistula can be prevented by stopping early marriages, delaying the age of first pregnancy and by timely access to good emergency obstetric care -- but education is also key.

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. 

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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

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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