We must break the silence around fistula

Bangladesh has earned global accolades for reductions in maternal mortality and yet, when it comes to sustained access to skilled healthcare professionals for women, we have a long way to go. According to a report by this daily, 20,000 women suffer from fistula (obstetric, iatrogenic, traumatic and congenital) in the country. Of them, the highest number suffer from obstetric fistula. Other than congenital cases, fistula is a result of prolonged, obstructed labour, or surgical error during c-sections, or injury from sexual violence. Women who develop this condition suffer from incontinence, and may face depression and social isolation eventually.

It is unfortunate that even with the advancement in maternal healthcare in general, it is the poor who are having to suffer disproportionately due to lack of access to quality healthcare. In urban slums, for example, women often prefer to give birth at home because of poverty and miss out on the recommended antenatal care (ANC) check-ups. In fact, many women develop fistula for not having access to quality maternal care during pregnancies and at childbirth.

There are doubts about whether the number of fistula patients recorded is a true representation of the real picture as many women do not speak openly about ailments pertaining to reproductive health due to sociocultural issues. That so many women – there are nearly half a million globally – still suffer from fistula, despite it being preventable, is reflective of gross inequities. It is a sign that inequality is still embedded in the healthcare system with the poor particularly vulnerable, as they also are in case of any health emergency.

Therefore, we urge the government to prioritise maternal healthcare for the poor and increase coordination among all stakeholders providing healthcare services so that no one is left behind. Community clinics should ensure that they are fully operational and provide antenatal check-ups for expectant mothers regularly. Surgeons too must be trained to ensure error-free procedures. On a policy level, the government must eradicate child marriage and ensure timely and quality obstetric services to prevent fistula in the first place.