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“I didn’t know what happened to me after I gave birth to my first child. I had uncontrollable discharge of faeces and urine,” said Arifa, 22.

Arifa was afflicted by obstetric fistula, a child birth injury, usually caused by prolonged and/or obstructed labour. It is an injury that affects women who are among the most vulnerable populations in developing countries, mostly illiterate, poor, young women, living in rural areas with no access to healthcare facilities.

 “Obstetric fistula leads to shunning of the women afflicted by the ailment, leaving them ostracized, with many people around them believing that they are cursed by God. Which is why they don’t seek medical care in time, worsening the situation further,” says Dr. Rahmatullah Niazmal, UNFPA program officer.

Arifa lives in the remote Tejab village in Almar district of Faryab Province, where access to healthcare is a luxury for most people, rather than a common service. In such remote areas, deliveries are attended by a Daya, traditional birth attendants, with very poor skills of managing normal deliveries, more so complicated ones.  

“I got married when I was 21, and got pregnant soon. Everything was going well, until it was time and the labour pain started”, Arifa recalls, “I was in grave pain and the daya said the baby was too big, after many hours of pain, I had no energy left, the baby was born forcefully after the daya pushed on my stomach. My baby survived, but I soon realized my state.”

The desperation and shame associated with obstetric fistula

Arifa and her mother were at the end of their tether until they visited a doctor in Maimana who referred them to Malalai Hospital in Kabul. There they met Dr. Shukria Zaman, an obstetric fistula surgeon trained by the United Nations Population Fund. “When I first met Arifa, she felt embarrassed, I knew she had been through a lot of suffering. I explained what had happened to her and what obstetric fistula was. I tried to comfort her by telling her that she was not the only one who suffered the condition,” said Dr. Zaman. Soon Arifa went through surgery for her injury.

When I first met Arifa, she felt embarrassed, I knew she had been through a lot of suffering.

The estimated cost of treating fistula per patient is 400 US Dollars. UNFPA covers round trip and living costs of the patients and accompanying family members during the treatment.

“Obstetric fistula is preventable in most cases if the pregnant woman delivers in a health facility where a C-section is possible. Antenatal care is vital so that midwives and doctors can discover early signs of an obstructed labor and advise the women to go to hospital on time.  

Obstetric Fistula Treatment Centre at Malalai Maternity Hospital is one of the two Public Fistula Treatment Centres across the country funded by UNFPA. The other is the newly established centre in Herat provincial hospital, as part of UNFPA’s efforts to increase access to fistula treatment to all zonal hospitals in the country, so that patients don’t have to trek for long journeys to access treatment in Kabul.