‘20,000 women suffering in silence’

Ensuring access to maternal services from skilled healthcare professionals is urgent since around 20,000 women still suffer from fistula in the country, according to experts.

Obstetric fistula is a hole between the birth canal and bladder and/or rectum, caused by prolonged, obstructed labour without access to timely, and high-quality medical treatment.

Another type of fistula termed an Iatrogenic fistula, is caused by a surgical error, most often during cesarean section.

Besides, traumatic fistula is caused by injury -- for instance, through sexual violence, female genital mutilation, or accidents, according to physicians.

It leaves women and girls leaking urine, feces, or both, and often leads to chronic medical problems, depression, social isolation, and deepening poverty, according to the UNFPA.

In 2021, the majority of the patients were found in Rangpur and Sylhet divisions, according to the last Annual Report on Obstetric Fistula in Bangladesh.

It is estimated that some 300-400 women turn to fistula patients countrywide each year for not ensuring quality maternal care during pregnancies and at childbirth.

"Although the number of fistula patients is significant, we have to keep working to make a fistula-free country. Because it is preventable," said Prof Dr Rowshan Ara Begum, former president of Obstetrical and Gynecological Society of Bangladesh.

Among all the fistula patients found in 2021 countrywide, a total of 524 were admitted to 15 selected facilities, according to the report.

Of the cases, a total of 273 cases were found to occur due to obstetric causes, while 191 cases occurred due to iatrogenic causes (surgical mistake); six of the cases were congenital and seven were traumatic.

Among the iatrogenic fistula patients, 77 cases were linked to C-section, 106 were associated with hysterectomy, and five with laparoscopy.

Among them, 477 patients were operated on with 17 days of hospitalisation on average.

More than 94.5 percent of the surgeries were successful while around 5.3 percent of the patients failed to completely recover, according to the report.

Dr Md Azizul Alim, program manager (maternal health) at the health directorate told The Daily Star yesterday, "Ensuring at least four-time antenatal checkups for pregnant women to any qualified doctors or facility is urgent to avoid such health problems."

Preventing child marriage is also important since young girls are not physically mature for pregnancy, he added.

Prof Dr Rowshan Ara Begum, meanwhile, stressed training the surgeons to avoid errors during cesarean section or uterus surgery.