Obstetric fistula is a hole. A tear between walls that should never open. It happens when labour is too long, the body too small, the help too far away.
In the rural belts of southern Punjab and interior Sindh, girls are still married before their bones have finished growing. When pregnancy follows, as it almost always does, their underdeveloped bodies face an ordeal no child should face. These are two of those stories.
Amam Zadi, married at 14 — Goth Ghulam Muhammad, Mirpur Khas, Sindh
Amam Zadi grew up in a small farming settlement outside Mirpur Khas, a household of debt and dust, where parents bent their backs in other people's fields. She was a slight girl, small-framed even for her age. At fourteen, the community decided she was old enough for marriage. At fifteen, she was pregnant.
The local Lady Health Worker had visited Amam during her pregnancy and raised the alarm early: the baby's position was awkward, the pelvis narrow, the risk real. She needed a hospital. Her husband had gone to Karachi for work. When labour began, it was Amam's mother-in-law and brother-in-law who made the decisions.
They took her to the nearest clinic. There was no doctor. There was no surgical facility. There was only a nurse and a family that refused to move.
"My mother-in-law told the nurse that she has only ten thousand rupees so I cannot be transported to the hospital in the city. Whatever had to be done had to be done at the clinic. I was in so much pain. My baby girl also died in the ordeal and I had this disease. My husband told me they cannot take care of me like this. My father told my husband that his daughter is not dead yet, and brought me back."
For years after, Amam lived with fistula and the constant leakage, the shame, the withdrawal from ordinary life. The husband who would not keep her. The disease she did not understand. A mind that had once dreamed of school and a vocation, now crowded only with grief.
"I was sick of my life, I had no interest in living," she says. "I wanted to study, be educated and work, but that is how my life ended up, due to the customs of our community. I had to be married as puberty hit."
It was a woman in her village whose niece was a nurse in the city, who finally told her the words that changed everything: there is a free facility for fistula treatment in Karachi.
Amam Zadi underwent a successful repair surgery at Koohi Goth Hospital. She is now home and recovering, cared for, at last, by the parents who refused to give up on her.
Bilqees, married at 16 — from a village in southern Punjab
Bilqees hailed from a small village in Bahawalpur district, southern Punajb. She belonged to a poor family, her parents worked hard to provide for the family, yet the income was meagre. Life was difficult.
Bilqees was married at the age of 16 and dreamt of becoming a mother and starting a family, yet her problems grew. During childbirth, severe complications occurred. The labour pain continued for many hours, as the family tried to attend the birth at home. There was no medical facility nearby, her condition became critical. After multiple failed attempts to deliver the baby, she was eventually taken to a local clinic, but it did not have the equipment or specialists needed. After a long delay, she was referred to a bigger hospital, but by then, her condition had worsened badly.
The baby could not survive. And after the delivery, she started suffering from the continuous leakage of urine.
"At first I did not understand what was happening. I felt ashamed and frightened. The smell and constant wetness made my life miserable. People around me began to avoid me. Relatives and neighbours whispered behind my back, and slowly I became isolated from society." Bilqees said.
“My husband changed too. Instead of support, he became distant and cold. I spent many nights crying silently, wondering why this had happened to me. I lost my confidence and stopped meeting people.”
Then someone in her community told her family about UNFPA-supported Koohi Goth Hospital. With little hope left, she made the journey.
The doctors examined her carefully and explained that to her that she was suffering from obstetric fistula — caused by prolonged obstructed labour. Bilqees was scared of the surgery after traumatic labour experience, so she was give psycho-social support and reassurance by the staff.
Bilqees underwent the surgery at UNFPA-supported Koohi Goth hospital and her fistula was successfully repaired.
“After a few days of recovery, my condition started improving. For the first time in many months, I felt normal again. The pain, embarrassment, and loneliness slowly disappeared. I began smiling again.” Bilqees said.
‘Today, I want every woman to know that fistula is treatable. No woman should suffer in silence or feel abandoned because of this condition. With proper medical care, support, and awareness, women like me can return to a normal and dignified life.’
The doctor's view
Dr. Sajjad Haider, Surgeon, Koohi Goth Hospital — Centre of Excellence for Fistula, Karachi:
"The cases of child brides and teen mothers mostly come from rural areas — especially interior Sindh and southern Punjab. The girls suffer in obstructed labour due to a lack of both facilities and awareness. They are too weak due to poverty and young age. Their bodies get bruised and injured during the process. The flow of cases has increased due to awareness campaigns with support from UNFPA. Now people know there is a cure."
Obstetric fistula is not fate. It is the product of child marriage, poverty, and the absence of care at the moment it matters most. Every woman who reaches a facility like Koohi Goth Hospital has already survived the unsurvivable. They deserve more than surgery — they deserve a world where the surgery was never needed.
The Centre of Excellence for Fistula, supported by UNFPA, repairs more than 800 fistulas every year. The Centre also trains surgeons to avoid fistula caused by surgical injuries during surgeries.
