Telling her story: five women on the debilitating impact of obstetric fistula

Monica suffered stigma and isolation stemming from fistula for a year before she received treatment. © UNFPA Malawi

Obstetric fistula is one of the most dangerous and most misunderstood birth injuries.  

It occurs when a woman experiences prolonged labor–often for several days- and is unable to access emergency delivery care. The baby can cut off blood flow to tissues in the mother’s pelvis. Once the baby has been delivered, the dead tissue falls away, leaving a hole in the birth canal that may leak urine or feces.  

Even worse, obstetric fistula is closely associated with stillbirth, with over 90 percent of women who develop a fistula also losing their babies. 

UNFPA works to end obstetric fistula and save mothers and their babies.

Here, five women speak to the impact that obstetric fistula has had on their lives: 

Razia in Pakistan 

Fistula caused Razia to have a hard life, but now she lives happily with her family. © UNFPA Pakistan

Razia grew up in the Punjab region of Pakistan, and by all accounts, she had a hard life.  

Her family held traditional attitudes toward women, leaving Razia without an education and married by her 13th birthday. She became pregnant soon after, but, tragically, her husband died 6 months into her pregnancy. Razia gave birth alone, except for a traditional birth attendant who was unable to care for her complications. She was in labor for 4 days, before finally giving birth to a stillborn daughter.  

In the process, Razia developed multiple fistulas, which she lived with for years, saying “People would either avoid me or just make fun of me. I never felt clean.” 

She was finally able to receive care at a UNFPA clinic. Razia had to have multiple surgeries over 6 years, due to the complexity of her injuries, but now, she has her life back. She has married, adopted one child, and much to her surprise, was able to conceive and give birth to a healthy baby girl.  

As tragic as Razia’s story is, it is not uncommon.  

Adolescent pregnancy is incredibly dangerous and is the biggest killer of girls 15-19 in the world. Girls’ pelvises, even if they’ve gone through puberty, are not developed enough to deliver a child. In too many cases likes Razia’s, this can result in obstetric fistula, other birth injuries, or death.  

Keflene in Tanzania 

Keflene (center) with other fistula survivors at a health facility in Tanzania where they are receiving treatment. © UNFPA Tanzania/Bright Warren

“I started attending prenatal clinics as soon as I realized I was pregnant, and continued throughout my entire term.” 

Sadly, even if you follow every guideline, like Keflene, obstetric fistulas still happen.  

Kefelene lives in a rural and impoverished part of Tanzania, which made it impossible for her to go to a hospital when she went into labor. Instead, she had a traditional birth attendant, who was unable to help her through three days of labor. Eventually, Keflene’s baby was stillborn and Keflene spent over a month in the hospital recovering from complications from the delivery.  

UNFPA-supported research found that transportation costs were a major factor for Tanzanian women when they were deciding whether to give birth at home or at a hospital. Just under two-thirds of women have a skilled birth attendant with them during delivery.  

Luckily, Keflene was able to receive fistula repair surgery and is now an advocate for other women living with fistula. 

Palesh in Nepal 

Palesh suffered from an obstetric fistula, a debilitating childbirth injury, for 21 years. She endured pain, stigma and social isolation before receiving free reconstructive surgery from a UNFPA-supported campaign. © UNFPA Nepal/Santosh Chhetri

Palesh was married to a man she had never met at the age of 17. She then had a series of pregnancies, her sixth of which ended horribly in a stillbirth and an obstetric fistula.  

Palesh lived with her condition for 20 years, not knowing that repair surgery was an option. She thought she would leak urine forever, driving herself deeper into isolation.  

“I was thinking that I would leak urine throughout my remaining life and there was no cure for my suffering. I was always ashamed to leave the house because of the smell,” 

Thankfully, with UNFPA’s help, she was able to receive repair surgery. Like Palesh, it is not uncommon for women to live with a fistula for years, oftentimes because they don’t know that repair surgery exists, or because medical and transportation costs are prohibitive.  

Margret in Malawi 

Margret and her husband tried for years to find a cure. “When you are
in that situation, you try almost everything,” she said. © UNFPA Malawi/
Henry Chimbali

Margret lived with a fistula for 13 years before finding help.  

She became pregnant at 14 and suffered a hard delivery, ultimately resulting in her condition and a stillbirth.  

Like many women who experience fistula, she faced chronic health conditions. Recurring infections, depression, and anxiety are all common to these women. Margret’s husband stayed with her, but many women’s husbands or families abandon them after they develop the fistula, further isolating them when they need support most.  

Margret said, “I never enjoyed being a woman since I had this condition. It was tough to live.” 

Margret was able to receive fistula repair surgery at a UNFPA-supported event. Now, she had two children and is an advocate for other women living with fistula.  

Nagat in Yemen 

Najat suffered a traumatic birth injury, and nearly died, after her in-laws refused to take her to a hospital during labour. © National Midwives Association/UNFPA

Nagat is a midwife in Yemen. She knows exactly how dangerous fistula can be and how to prevent it from ever happening in the first place.  

But during her first pregnancy, she lacked the power to make her own reproductive health choices. Her husband’s family viewed the hospital as a “luxury” and as Nagat explains, “I stayed for four days suffering from pain trying to give birth, but in vain. My body was exhausted, and I was physically and psychologically worn-out.” 

Eventually, Nagat was able to have a Caesarean section delivery, and miraculously, her baby survived! Soon after, however, she realized she had an obstetric fistula. Unable to resume her household duties, her husband left her and took their child with him.  

After 7 months, Nagat and her family were able to save enough money to transport her to a clinic that performs repair surgeries for free. Now, Nagat misses her daughter terribly, but is able to ensure other women receive the care they need and don’t have to experience fistula like she did.  

A medical team who treats obstetric fistula in Yemen. © UNFPA Yemen

Obstetric fistula turns women’s lives into a living nightmare, constantly worrying if they’re going to be the subject of ridicule or left abandoned because of something they cannot control. Fistula is easily preventable by a timely Caesarean section, and, in the industrialized world, the procedure has basically eliminated this tragic situation. But, for 2 million of the world’s most marginalized women – women who live in poverty, with disabilities, lack agency over their lives, were child brides or who have experienced FGM– obstetric fistula is just one more thing in a laundry list of hardships that they face every day.  

UNFPA is working to eliminate obstetric fistula by 2030 through clinics that provide free fistula repair surgery, by training and supplying midwives who are essential to ensuring that mothers have a safe delivery, and by training survivors of fistula on how to become advocates in their communities. 

-Dana Kirkegaard

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