15 April 2009 - Sabza Bibi, 24, mother of two children is admitted to the Malalai hospital in Kabul due to an obstetric fistula. She developed this condition almost two years ago when she was in labour pain for two long days. By the time Sabza Bibi got to the health facility, she had developed life-threatening complications.

Unfortunately, not only did she loose her baby, but she also developed obstetric fistula. “I was married to my husband when I was too young to know about marriage and I don’t even remember how old I was. Since I was an orphan, without my parents to take care of me, I lived with my brother-in-law. One day, when my sister was away from home, my brother-in-law fixed my marriage,” said Sabza Bibi.

Sabza’s husband married another woman just a few months after marrying Sabza. This increased their marital problems to levels which were very difficult for her to cope with.

“When I gave birth to my third child, which I lost during delivery because of complications, I noticed that I had lost control over my urine flow. This put me in the most embarrassing situation because I started smelling, which caused me more misery in life - nobody could come near me. Consequently, my husband threw me out of our home. I had no refuge elsewhere, so I had to go to my sister’s house and started to live in the most miserable condition one can imagine.”

Some months ago Sabza came from Tagab, a district of Kapisa province to Kabul after she learnt that another woman with the same problem completely recovered in a Kabul hospital. It was at the Malalai Fistula Repair Centre that she came to know that the complications she had while giving birth had left a hole in her bladder, a condition known as obstetric fistula, which had changed her life completely.

Sazba underwent her first surgery in one of the hospitals in Kabul, but unfortunately it was not successful.
She then had the second surgery done at the Fistula Centre of Malalai hospital but this was not successful either and her life did not change. In spite of this, Sabza was determined not to give up hope of a complete recovery one day and start living a normal life.

“I do not want to return to my husband. He threw me out of his life when I needed him the most. I have very strong hope and faith that one day I will get perfectly well and live a healthy and normal life again. I will try to find a job for myself and stay here or I will go and live with my sister,” adds Sabza.

Indeed as she says this, one can clearly see the strong hope for complete recovery from this major health problem reflecting in her eyes. There are many women who have complications due to their lack of access to health facilities and skilled health workers. Obstetric fistula can be considered as one of the most serious complications for women during child birth.

Marie Mangal, UNFPA Coordinator at the Fistula centre in Malalai hospital explains that obstetric fistula is a childbirth injury which is caused by prolonged obstructed labour due to inaccessibility or unavailability of maternity services. The consequences of fistula are life shattering as often the baby dies and the woman is unable to control her flow of urine or faeces, or both.

According to Dr. Bashir Najeeb, a Programme Officer with UNFPA, Afghanistan, “the maternal mortality rate of 1,600 maternal deaths per 100,000 live births in Afghanistan is one of the highest in the world. Too many women die needlessly from complications of pregnancy and childbirth. One of these complications is obstructed labour which can lead to obstetric fistula.  Poverty is an indirect but main risk factor for obstructed labour and fistula, as it is the poorest women who are most vulnerable and have limited access to these services."

Inadequate nutrition, stunted growth and traditions of early marriage and pregnancy all contribute to the likelihood of obstructed labour and fistula. Women with fistula not only suffer from poor health but are also subject to increasing vulnerability due to the social stigma attached to the condition. In 2008, 221 obstetric fistula patients underwent surgery in the Fistula Centre of Malalai hospital - 209 cases were successful.

To provide fistula care and management services, UNFPA is supporting the government through the Ministry of Public Health.

By Asma Rahimi, UNFPA

Website: UNFPA Afghanistan