"Usually women don't or can't go to a health facility during pregnancy and delivery, they marry too young and or suffer malnutrition, such issues cause complications in pregnancy and delivery and result in a prolonged labor which ultimately causes fistula", Said Dr. Mohammad Tahir Ghaznavi, UNFPA National Program Officer for Fistula in Afghanistan. Economic instability, scarce job opportunities, very low literacy rate, wide practice of early marriage and cultural and security barriers hindering women from seeking education and jobs beyond the house walls among others have added to the challenges on the way of providing reproductive health care to the Afghan mothers.

UNFPA supports the Ministry of Public Health (MoPH) technically and financially to provide reproductive health care in Afghanistan. As part of such efforts in 2007 UNFPA established a Fistula Ward at Malalai Maternity Hospital to make fistula treatment possible for the first time in the country. Additionally, UNFPA works with professional societies of Afghanistan Society of Obstetricians and Gynecologists (AFSOG) and Afghan Midwives Association (AMA) to train their members on prevention, early diagnosis, first aid and referral services to Malalai Maternity Hospital for fistula patients. In 2012, in addition to hundreds of other patients with obstetric problems, the Fistula Treatment Center treated 48 fistula patients from all over Afghanistan. Obstetric fistula is an unnatural passage or hole in the birth canal caused by prolonged labor without immediate medical intervention. The mother then suffers from lack of control over urine and or feces, and most often the result is a stillborn baby.

While fistula causes physical and psychological scars to a mother, the smell of leaking urine and/or feces leaves her in absolute solitude. In most cases the husband dumps the patient at her father's house with no support of any kind. One of such many stories is that of Rahila (Rahila is the name given to the woman who refrained to disclose her identity). "I have suffered this problem for ten years", said Rahila. "My husband brought me to my father's house and left", She added in dismay.

"One of the challenges is that obstetric fistula patients take too long to come to Malalai hospital after they contract fistula. The reasons might be either economic, cultural or unawareness of the possibility and facility at Malalai hospital to treat fistula, but my message to the Afghan people is that Fistula just as any other curable health problems can be treated. People should be determined to come to us and seek treatment. At Malalai maternity hospital with the support of UNFPA we are well able to help them" Said Dr. Nazifa Hamrah, Head of the Fistula Center at Malalai Maternity Hospital.

As its continuous efforts each year UNFPA invests on public awareness about fistula, its causes and treatment at the Fistula Ward in Kabul. "UNFPA is addressing fistula all over Afghanistan. We are increasing our awareness efforts and support to the Fistula Ward. Our aim is to build the capacity of the Afghan doctors, gynecologists and midwives working there", Said Dr. Laurent Zessler, UNFPA Representative. The fistula patients who get treated go back and join their community and live a normal life. UNFPA also plans to use these women as advocates to help UNFPA spread awareness about fistula and its treatment in their communities.