Pakistan: Women with obstetric fistulas face harsh discrimination

Thirty-year-old Rehana Qadir Dad had hoped to complete her education and work in a profession of her choice, but couldn't do so after forming an obstetric fistula during the birth of her third child.

Dad, who is from the Ali Maher village of Ghotki, a town in southern Sindh province of Pakistan, is one of the thousands of women each year who suffer from the injury, in which a tear between the birth canal and bladder forms during prolonged labor.

The pain is not limited to the physical condition, however. Women who form obstetric fistulas in Pakistan are often discriminated against, thrown out of their homes or socially ostracized.

Despite her hopes to continue her higher education, Dad was married in 2012. While weddings are usually a happy occasion, in her case, "it turned out to be a nightmare," she told DW.

Dad said her husband was abusive and frequently violent.

She added that she had tolerated her husband's abuse for the sake of family honor, but things took an ominous turn in November 2020, after she gave birth to their third baby.

"My surgery was complicated," Dad said. "I was taken to a hospital in my area where a nurse mishandled my case, causing immense bleeding and extreme pain."

"I do not know what happened to me," she said, adding that she had warned her husband repeatedly that she had an infection and urgently needed to see a doctor.

When she warned him, "he started hurling insults at me, kicking and hitting me," she said, fighting back her tears.

"I did not know what an obstetric fistula was, but one woman in my village had the same problem," she said.

Shaming women for their condition

Dad said many people began to shame her.

"Wherever I went out in my area, staring eyes would chase me," Dad said. "People would mock me, hurling insults and saying that I would never be able to become a complete woman again and would not bear any more children. Nobody wanted to come close to me."

"Even my in-laws would burst into laughter when they noticed leaked urine," she said, adding that her sister, who was married at the time to her husband's older brother, would wash her shalwar, or pants, several times a day.

Dad's father additionally offered her support in seeking treatment.

"He took me to Sindh and Punjab in search of treatment," she said. "Bus drivers would utter slurs and insults at him for bringing me onto public transport, but he tolerated all of this in silence with tears in his eyes," she added.

A female doctor who examined Dad later assured her that she could be treated at the Koohi Goth women's hospital in Karachi.

She said her family took her to Karachi immediately, where she had an operation for her obstetric fistula in March 2021.

"Now, I am perfectly healthy and doing a midwife course," Dad said, adding that she wants to create awareness around this preventable condition.

She said, however, that she is still paying the price for her illness. "I have three kids, but my husband has snatched away two of them," she said, adding that she hasn't seen her children in months.

Dr. Sana Ashfaq, a gynecologist and endoscopic surgeon working at the hospital where Dad was treated, said she was just one of many Pakistani women to face such hardships. "Such women, mostly aged between 18 and 35, are often separated from family, and experience divorces, social problems, slurs and insults," she said.

Traveling also becomes a nightmare for these women because the bus drivers could throw them out for leaking urine, Ashfaq said.

Women thrown out of family homes

Dr. Shaheen Zafar, a health expert from Karachi, said patients had to listen to a lot of taunting. "People say the patient is sinful and cursed by God or that she has been overwhelmed by evil spirits," Zafar told DW.

"They are first thrown out of their husband's bed, then out of their homes," she said.

Women suffer greatly for a disease that can be treated easily if patients are brought in early for treatment.

Ashfaq revealed that most of the women suffering from this condition are from less-developed or remote areas of the country and do not have enough money to travel to the hospital.

"While we at Koohi Goth hospital treat them freely, at private hospitals even the initial tests could cost Rs 20,000 to 35,000 (€100-175, $113-199), while surgery could be very costly at elite private facilities. Given the costs, many people go to mystics or traditional healers who further complicate matters," Ashfaq said.

Meanwhile, Zafar believes that untrained birth attendants in villages are also responsible for offering faulty health care and complicating the problem.

Zafar believes that the disease is heavily under-researched. She tends to rely on data from the Fistula Foundation, which claims that around 3,000 to 3,500 cases of obstetric fistula occur in Pakistan every year. "At Koohi we operate on 20 to 25 women every month, but this is just one health facility in a country of around 220 million people," she said.