n the hall at Peshawar Press Club, medical experts, gynaecologists and health officials gathered recently not just to share information, but to also raise their voice against an often-ignored condition silently wrecking lives across Pakistan: the obstetric fistula.

The seminar, organised by the Pakistan National Forum on Women’s Health, brought to the surface a grim reality faced by hundreds of women, especially in remote areas of Khyber Pakhtunkhwa, a reality shaped by poverty, medical neglect, childhood marriages and social stigma.

Obstetric fistula, a condition caused by prolonged and obstructed labour without timely medical intervention, creates an abnormal opening between a woman’s birth canal and bladder or rectum, leading to continuous leaking of urine or faeces. It’s a preventable and treatable condition. However, in many rural communities, it still carries a social death sentence for the afflicted.

“It is not just a medical issue, it’s a social issue as well,” said Dr Nazish Hayat, an associate prof in gynecology at Lady Reading Hospital. “Women suffering from fistula are often isolated. They are confined to separate rooms, abandoned by their families and are seen as a burden instead of patients in need of care.”

Fistulas are most prevalent in underserved rural areas where access to skilled birth attendants and emergency obstetric care is minimal. Many victims are girls married before their bodies are prepared for childbirth.

Dr Nazish Hayat described how many women silently endure the uncontrollable urine leak for years, too embarrassed to speak up or unaware that their condition is treatable. “They don’t know that a fistula can be treated and is treated here for free,” she said. “Now, specialised centres have been established in various parts of the country, including Mercy Hospital, Peshawar, which offers surgical intervention at no cost.”

The problem runs deeper than just medical facilities. In the conservative social fabric of many districts, women are discouraged from discussing reproductive health issues. Those suffering from fistula are often blamed for their condition.

“We have seen cases where husbands abandon their wives, or families treat them like outcasts,” said Dr Matiur Rehman, the head of department at PMIS Hospital, Peshawar. “This is not a punishment. It’s a disease that can be cured. Instead of turning away, families should support the suffering women and get them the help they need.”

Fistula is most prevalent in underserved rural areas where access to skilled birth attendants and emergency obstetric care is minimal. Many victims are young girls married before their bodies are prepared for childbirth.

Dr Rehman emphasised the government and non-profit sector’s role in offering free treatment. He regretted that public awareness was dangerously low.

“Free treatment is available in Khyber Pakhtunkhwa, but many women never hear about it,” he said. “There’s an urgent need for awareness campaigns at the grassroots level. We are now training community health workers and midwives not only to identify the condition but also to counsel women and guide them to the right facilities.”

Fistula often arises when childbirth takes place at home without professional supervision, especially in cases of prolonged labour. Women from low-income backgrounds are most vulnerable. “Training more female midwives and strengthening maternal health services in remote areas is essential,” he says.

Dr Azra Ghani, a urologist at LRH, explained the mechanics of the condition and how it unfolds. “In obstructed labour, the baby’s head presses against the mother’s pelvic bone, cutting off blood flow to the soft tissues. This leads to tissue death and the formation of a hole or fistula between the bladder and the vagina. The result is constant urinary incontinence.”

She noted that women who marry and conceive at a very young age or older women who have had multiple births are particularly at risk. “The tragedy is that these women are doubly punished first by the physical trauma, and then by their community’s rejection.”

Despite the odds, she also shares hopeful stories of hundreds of women who have undergone successful surgeries and returned to normal lives. “But for every woman we reach, there are many hidden away in shame,” she said.

Pakistan is making strides in maternal and reproductive healthcare, but gaps remain, particularly in ensuring rural access to emergency obstetric care and ending early marriages.

“Fistula is a poor woman’s disease,” Dr Ghani said. “But 95 per cent of the cases are treatable. What we need is a sense of urgency among policymakers, communities, and healthcare providers.”

Dr Nazish Hayat called on families to support affected women and bring them to hospitals. “We must end this cycle of neglect. A healthy woman is the backbone of a healthy home. Treat her with dignity, not disdain.”

Obstetric fistula may be a silent epidemic, but the silence is being broken. With increased awareness, training of healthcare workers, free surgical treatment and community support, there is hope that Pakistan can eliminate this devastating condition.

The writer is a freelance journalist based in Peshawar.