Obstetric Fistula: A Challenge for Early Marriages

KARACHI, Pakistan, Apr 13, 2012 (IPS) :
As is the custom in the remote mountain village of Kohadast in the Khuzdar district of Balochistan province, Bano was married off as soon as she reached adolescence, at 15, and was pregnant the following year.

There being no healthcare facility near Kohadast, Bano did not receive antenatal care and no one thought there would be complications. But, events were to prove different.

After an extended labour lasting three days, Bano delivered a dead baby. "I never saw the colour of my son’s eyes or his hair. I never held him once to my bosom," recalls Bano. Unknown to her the prolonged labour had taken a toll on Bano’s young body. She had developed a fistula caused by the baby’s head pressing hard against the lining of the birth canal and tearing into the walls of her rectum and the bladder.
A week after the childbirth ordeal, Bano realised she was always wet with urine and reeking of faecal matter. "I was passing urine and stools together."

Bano’s family attributed her condition to fate, her father refusing to visit "due to the bad odour coming from me." However, through those trying times, Khan stood by his young wife and sought medical help.

After Bano spent a year in a perpetually "wet and stinky" condition, her husband finally discovered a hospital in Karachi specialising in treating fistula and other conditions related to reproductive health. "I smell nice now and it’s all because my husband wanted me to get well," said Bano, who may have spent many more years in a miserable state if not for the treatment at Koohi Goth.


Kenya, 2010: Human Rights Watch

Kwamboka became pregnant at age 13 while in primary school, developed fistula, and lived with it for seven years before hearing on the radio about a United Nations Population Fund (UNFPA) funded fistula repair camp offering free surgeries. She told us, “I didn’t know anything about family planning or condoms. I just went once and got pregnant.” Despite some government efforts to introduce sexuality education in upper primary and secondary schools, its teaching remains awry given the lack of ownership ( not part of the official syllabus) thus lack of time allocation.

Malindi Kenya, April 2012: M. Mwaila

13 girls in upper primary in a school in Watamu are currently pregnant! Given their immature bodies, all face the danger of developing fistula at childbirth especially considering the poor healthcare and rights awareness within the community, poverty levels, as well as fear of being reprimanded by healthcare workers leading to lack of access to antenatal care. According to a local CBO working on GBV issues, one of the girls said lack of sanitary towels was the major reason girls engaged in sex. Rose (not her real name) intimated that her mother has no money to buy pads. Due to culture, Rose cannot approach her dad because it is taboo for a girl to discuss menses with her father. “Our alternative is to approach men who have cash. They give us money for pads and we pay back in kind – offer sexual favours”.

Sexuality education or even simple awareness is yet to happen in most schools. The burden of awareness creation has been abdicated to non-state actors. Some parents do not consider early sex/pregnancy a problem since the girls are allowed back to school after childbirth. These parents are not aware of the many dangers of early sex/pregnancies one of which is obstetric fistula.

The full global extent of obstetric fistula is not known. According to the World Health Organization, fistula strikes roughly 50,000 to 100,000 women and girls every year, mainly in resource poor countries in sub-Saharan Africa and Asia. According to a field research conducted by Human Rights Watch in November and December 2009 in hospitals in Kisumu, Nairobi, Kisii, and Machakos as well as in Dadaab in March 2010 in Kenya, “approximately 3,000 women and girls develop fistula every year, while the backlog of those living with untreated fistula is estimated to be between 30,000 and 300,000 cases. There are many doubts about these estimates because few studies have been conducted to establish the extent of this problem in the country. Fistula sufferers are mostly young women and girls with little education. They often come from remote and poor areas where infrastructure is underdeveloped and access to health care, particularly emergency obstetric care, is lacking.”

 
While obstructed labour can cause fistula, it also contributes to maternal and child deaths – two key indicators of a country’s healthcare. "For both physiological and social reasons, mothers aged 15-19 are twice as likely to die of childbirth than those in their 20s," says a UNFPA document. "Obstructed labour is especially common among young, physically immature women giving birth for the first time."  Poverty, illiteracy and socio-cultural practices force girls into sex and/or marriage during adolescence.

In addition to incontinence, the medical consequences of fistula include frequent bladder infections, painful genital ulcerations, infertility and kidney failure. “Obstetric fistula is now generally acknowledged to be another burden on the girl child, deprived of basic education and forced into sex or marriage - for which she is neither physically nor mentally prepared.”  IPS


"Khan is a cleric and yet he does not conform to the stereotype of a religious person," said Syed. "He tells parents that fistula can be avoided if they stop marrying off their daughters at a very early age." (IPS). It is about time our religious leaders, especially at the Coastal region emulated Khan to stop early marriages and child sex tourism. The Sexual Offences Act 2006 is clear on offences meted on children (below age 18). For example, Section 12 talks about promotion of a sexual offence with a child; Section 14 on child sex tourism; Section 15 on child prostitution and Section 29 on cultural and religious offences. All these attract minimum sentences of 5-10 years which can be enhanced at the discretion of the judge.