Motherhood in Childhood

can increase the risk of miscarriage, stillbirth,
premature birth and maternal death (Pathfinder
International, 1998; Balarajan et al., 2011;
Ransom and Elder, 2003).
A number of factors directly contribute to
maternal death, illness and disability among
adolescents. These include the girl’s age, her
physical immaturity, complications from unsafe
abortion and lack of access to routine and emergency
obstetric care from skilled providers. Other
contributing factors include poverty, malnutrition,
lack of education, child marriage and the
low status of girls and women (World Health
Organization, 2012b).
Health problems are more likely if a girl
becomes pregnant within two years of menarche
or when her pelvis and birth canal are still growing
(World Health Organization, 2004).
Obstetric fistula
Physically immature first-time mothers are particularly
vulnerable to prolonged, obstructed labour,
which may result in obstetric fistula, especially
if an emergency Caesarean section is unavailable
or inaccessible. Although fistula can occur
to women at any reproductive age, studies in
Ethiopia, Malawi, Niger and Nigeria show that
about one in three women living with obstetric
fistula reported developing it as an adolescent
(Muleta et al., 2010; Tahzib, 1983; Hilton and
Ward, 1998; Kelly and Kwast, 1993; Ibrahim et
al., 2000; Rijken and Chilopora, 2007).
Obstetric fistula is a debilitating condition that
renders a woman incontinent and, in most cases,
results in a stillbirth or the death of the baby
within the first week of life.
Between 2 million and 3.5 million women and
girls in developing countries are thought to be
living with the condition. In many instances, a
OBSTETRIC FISTULA: ANOTHER BLIGHT ON THE
CHILD BRIDE
It was personal experience that turned Gul Bano and her cleric husband,
Ahmed Khan, into ambassadors against early marriage and its
worst corollary—obstetric fistula.
As is the custom in the remote mountain village of Kohadast in the
Khuzdar district of Balochistan province in Pakistan, Bano was married
off as soon as she reached adolescence, at 15, and was pregnant the
following year.
There being no healthcare facility near Kohadast, Bano did not
receive antenatal care and no one thought there would be complications.
But, events were to prove different. After an extended labour
lasting three days, Bano delivered a dead baby. “I never saw the colour
of my son’s eyes or his hair. I never held him once to my bosom,” recalls
Bano, now 20.
Her troubles had only begun. A week later, Bano realized she was
always wet with urine and reeking of fecal matter. “I was passing urine
and stools together.”
Unable to handle the prolonged labour, Bano’s young body had
developed an obstetric fistula caused by the baby’s head pressing hard
against the lining of the birth canal and tearing into the walls of her
rectum and the bladder.
Obstetric fistula is now generally acknowledged to be another
burden on the girl child, deprived of basic education and forced into
marriage—for which she is neither physically nor mentally prepared.
Khan stood by his young wife and sought medical help. He discovered
a hospital in Karachi specializing in treating fistula and other conditions
related to reproductive health. Koohi Goth Women’s Hospital, where
fistula victims are treated free, was started by Dr. Shershah Syed, one
of Pakistan’s first gynaecologists to train in repairing the painful and
socially embarrassing condition.
“It’s been almost three years and she [Bano] has gone through six
operations,” says Dr. Sajjad Ahmed, who worked at Koohi Goth as manager
of UNFPA’s fistula project from June 2006 to February 2010.
Today Bano and Khan have become vocal advocates of the campaign
against fistula. They travel across Pakistan, spreading the word about
how to prevent the injury and what to do about it. “Khan is a cleric and
yet he does not conform to the stereotype of a religious person,” said
Syed. “He tells parents that fistula can be avoided if they stop marrying
off their daughters at a very early age.” Bano shares her story and
tells married women about the importance of birth spacing, antenatal
checkups and timely access to emergency obstetric care.
—Zofeen Ebrahim, Inter Press Service
THE STATE OF WORLD POPULATION 2013
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