Fistula Afflicts Child Brides in Bangladesh

Sonia Akhter became pregnant within a month after being married at age 14.

But her baby’s stillbirth shattered Sonia and her family’s joy, and her post-labor misery deepened when she contracted fistula, she said.

“I was the eldest child of my parents and was the most beloved in the family. But now I am a burden to everybody, as my husband also divorced me due to this [fistula],” Sonia, now 17 years old, told BenarNews in a recent interview in Dhaka.

Fistula is a condition that affects at least 19,755 women in Bangladesh, particularly those who were married off as girls and whose bodies are not yet developed enough to give birth, according to doctors and health experts in the country, which has the highest rate for child marriage in South Asia.

“Life becomes a real hell for someone who is affected by fistula. The patient’s body remains stinky at all times due to [fistula]. No one wants to come to her. For this reason no one offers her any job,” Sonia, a resident of northeastern Sunamganj district, said while recovering from an operation at MAMM's Institute of Fistula and Women’s Health (MIFWOH) hospital.

According to the United Nations Population Fund (UNFPA), “obstetric fistula is probably the most tragic childbirth injury confronting women in Bangladesh.”

It is caused “by untreated, obstructed and prolonged labor, which creates a hole between the birth canal and bladder or rectum, leaving women to leak urine, feces or both. It often leads to chronic medical problems, depression, social isolation, and deepening poverty,” UNFPA said.

Professor Sayeba Akhter, a Bangladeshi physician, was a pioneer in establishing the 20-bed MIFWOH hospital in Dhaka.

“Girls who get married and fall pregnant at too young an age are physically not mature enough to handle the strains of child birth. The physical injury is then exasperated by the emotional trauma of losing a child,” she told BenarNews.

In Bangladesh, at least 1,000 women are diagnosed with fistula every year, but a relative handful of doctors in the nation are properly trained to treat the condition, health experts said.

According UNFPA’s State of the World’s Population Report for 2019, Bangladesh leads all South Asian countries in child marriages. Between 2006 and 2017, the rate among minors in the country being married stood at 59 percent, the U.N. agency reported in April. Bangladesh’s overall population is 163 million people.

In February 2017, the Bangladeshi parliament passed a bill setting the minimum age for women to marry at 18 years old, but with provisions that allow younger brides to be married under special circumstances.

“Pregnancy during adolescence is the main cause behind the frequency of fistula in Bangladesh. More than 25 percent of patients diagnosed with fistula are victims of child marriage,” said Dr. Bilkis Begum Chowdhury, a Bangladeshi surgeon reputed for treating patients who suffer from fistula.

“The social stigma associated with obstetric fistula most often forces women into isolation and abandonment. In many cases husbands divorce their wives, families reject them and communities exclude those affected, driving them further into poverty,” she told BenarNews.

Ruhena Begum, who was married at age 16 and suffers from fistula, is among the other patients receiving care at MIFWOH.

“I have a husband, but it means little. I am living in isolation with fistula for three years. I cannot remember the last day, when I could sleep on a dry bed,” Begum, who also lost her baby during her pregnancy as a minor, told BenarNews.

“Now I am getting care in this hospital, and have slightly improved following a surgery.  I hope to get better soon. Please pray for me,” she said.

The hospital at which Sonia and Begum were being treated has cared for some 2,000 fistula patients since 2012, with a majority of them having been child brides, Dr. Akhter said.

A scarcity of physicians

Underage marriage is common mostly among poor people in Bangladesh, who are being affected by fistula in growing numbers, doctors and health experts said.

A scarcity of qualified and experienced doctors is a barrier to dealing with this health problem, said Dr. Sheikh Nazmul Huda, who directs the Fistula Care Plus project at EngenderHealth-Bangladesh, an NGO that focuses on women’s health and family planning, among other issues.

“There are only seven or eight doctors across Bangladesh, who are [capable] to handle fistula patients and conduct surgery,” he said.

“Skillful surgery is a must for curing fistula. A surgeon who is not habituated to conducting operations on at least 150 patients a year should not operate on a fistula patient,” he told BenarNews.

According to Abul Kalam Azad, who heads the government’s Directorate General of Health Services (DGHS), Bangladesh “most likely has 108 trained fistula surgeons, of whom 68 are staying in the country.”

But not all of them are active and “only four or five doctors” are mostly taking care of fistula patients, he said.

Some 600 to 700 fistula patients are operated on in the country every year, Azad said.

“If the other doctors had utilized their knowledge, [fistula] could be eradicated,” he told BenarNews, adding, “the government aims to eradicate fistula by 2030 and has established operation centers in 11 public health facilities. The patients are treated free of charge in those centers.”