The Wages of Childhood Marriage: Sidra’s Life with Fistula

With an eerie silence surrounding the small house, sits a ghost-like figure with barely enough flesh on her face. When asked to narrate her story, Sidra rounds up just enough energy to speak through her parched lips. Looking closely at her one sees the hollowness in her eyes. She is young, but the years have worn her down so much that she looks twice her age.

As Sidra starts to speak, it unfolds the circumstances that led to her current disposition. She was 15 when for the first time her family brought up the topic of her marriage. Her husband-to-be was 10 years older than her. She was far young and naïve to understand what marriage entailed and how she would manage. But the idea of new clothes and jewelry piqued her interest. Then the day of her wedding finally came. Very early on into the marriage, she realized that this married life was no child’s game.

She became pregnant a few months after her wedding. Her in-laws were ecstatic. She, however, was far too young to understand what this meant and the repercussions of this development for her future. During her pregnancy, she did not receive a lot of care as is the case with most young, pregnant women belonging to the under-privileged class.  As the time of her delivery came, there was no trace of a doctor, or a trained midwife anywhere. She was in latent labor for seven whole days, writhing in pain but saw no relief for days on end. The neighborhood midwife started trying all her methods, hoping that any one of the experiments would work and get her out of her misery. Sidra shuddered as she recounted events from that day, almost like she was reliving the entire turmoil while talking about it.

On the seventh day of excruciating pain and no end in sight, the midwife snatched a lifeless baby out from her body. During this time, due to complications of an obstructed labor she lost control over her bodily discharge (leaking urine and stool), a condition better known as Fistula. The lack of control over her basic bodily functions caused her severe distress since she could not hide it from anyone. She was left embarrassed and disgusted with her condition. She had lost so much just in a matter of a few days. The excruciating pain of the extended labor, the death of her child, and her loss of bodily autonomy over her organs were far more tragic than one can imagine.

She started smelling continuous, her clothes would always be wet and ruined, covered in her filth. The neighbors stopped visiting and called her impure. They all blamed Sidra for her condition, without giving it much thought as to what may have caused it. They even asked her to stop visiting them.

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but doesn’t have access to emergency medical care, such as a cesarean section. This often leads to tragic death of baby inside the womb.

The unfortunate women who endure such obstructed labors and resulting incontinence are often young, undernourished, uneducated, and married early. They are usually from rural, poor areas, often with early first pregnancy.

At this point, Sidra started crying uncontrollably while explaining what she went through. She went on to add that she would be covered in flies everywhere she went. That embarrassment, the sense of uncleanliness made her retire herself to one room. Her husband divorced her soon after and sent her to her parent’s house. She became a living corpse. She continued taking medications from Hakeem’s and other midwives and went to mosques for spiritual/religious treatment. This went on for 2.5 years. By this time, she had given up all hope. Then one day she got a visit from a lady health worker who advised her to visit a hospital in the city. Her mother looking at her daughter’s deteriorating condition decided to sell all her cattle and they set on a journey to get her the treatment she needed.

They first went to Quetta and then to Karachi. Sidra added,

“It was in that moment I got some hope that I might actually recover, that this torment would end. After going to several hospitals, I was directed to go visit Kohi Goth hospital and ask to see Dr. Sher Shah. I was informed that he treats women with this illness free of cost. He was my last hope. He was the only one who was not disgusted by me, instead, he gave me confidence and told me I had reached the right place. I underwent five operations and my issue has been resolved to a great extent.”

This is the story of only one such woman, countless women in the country have either lived through this disease and been made to believe that it is irrecoverable or are still experiencing this. There is little to no awareness surrounding this disease. Women who go through this accept the condition as their poor fate with no chance of escape. Under these circumstances, a woman with a fistula faces devastating physical and psychological consequences. Unable to control the leaking of their body’s waste, they suffer from chronic infections and pain. Too often, their smell drives away their husband, family, and friends. With little community understanding of fistula and its causes, a woman is frequently blamed for her condition. She too often lives in isolation, unaware that others share her injury and that it is treatable. Because fistula usually occurs during a woman’s first pregnancy — when she is in her teens or early twenties — she will likely suffer for decades, if it is not repaired.[1]

Society itself has made this out to be such a taboo topic that discussions around it are immediately disregarded. The entire blame in most cases is shifted onto the women, who end up losing their children (in most cases), their husbands, and their bodily autonomy, they are shunned to their rooms as people deem them unfit to meet. They are embarrassed and disgusted and yet they get no sympathy or help from society. However, this condition is reversible, it is treatable, something not many women know about. Awareness at the beginning, extra care, and trained doctors/mid-wives can help avoid this situation altogether, in case it does happen – with proper guidance and treatment the women can be treated and saved from a life of utter disgrace.

There is an undeniable need to raise awareness regarding the disease among women to avoid the longevity of the consequences. Had Sidra known about this, she could have avoided suffering for 2.5 years, could still be married, and would have avoided the embarrassment that ensued. A better grasp on the issue by the doctors, midwives, and lady health workers would go a long way and save countless lives in the midst of it all.

[1] “What Is Fistula?” Fistula Foundation, 1 Apr. 2022, https://fistulafoundation.org/what-is-fistula/.