For 10 years, Rokia Begum, a 37-year-old mother of six from a remote village in Sunamganj, suffered from obstetric fistula–an injury caused by prolonged and obstructed labour. Eventually, she was left alone to live in pain and humiliation -- abandoned by her husband, and shunned by her in-laws and friends.
Fortunately, Rokia found help and she was among the fortunate few whose condition was treated. In Bangladesh, an estimated 20,000 women live with obstetric fistula, but for these women the story of Rokia is far from the norm.
Pregnancy is often one of the most beautiful experiences for a woman, however, it is fraught with an inherent risk of complications, including obstructed labour and risk of obstetric fistula, particularly when deliveries occur outside of medical settings. Fistula results in a devastating loss of bodily functions, with urine or faeces leaking from the damaged birth canal. Without timely surgical interventions, the condition can become permanent, leading to both physical suffering and profound social consequences such as stigma, social isolation, and economic hardship. The injury not only impedes their autonomy; it increases their vulnerability to gender-based violence and further marginalization.
It is important to recognize that obstetric fistula disproportionately affects women and adolescent mothers. Factors such as poverty, the prevalence of child marriage, and the lack of affordable maternity care significantly increase their risk. A pressing concern is the high rate of home deliveries in Bangladesh, with 35% of deliveries occurring at home, often assisted by untrained birth attendants.
Pregnancy is often one of the most beautiful experiences for a woman, however, it is fraught with an inherent risk of complications
Furthermore, while 65% of deliveries are facility-based, only 30% take place in government-run institutions. This highlights the need to address the quality of healthcare and services available in these facilities. Women living in urban slums face a particularly challenging situation. The absence of quality maternal care often pushes them to choose between home deliveries or expensive private facilities, neither of which guarantees safe, secure, and quality care.
While gaps exist, there is much to celebrate as well. The government of Bangladesh has made commendable strides in addressing obstetric fistula as part of the global End Fistula Campaign. Between 2019 and 2023, 2,465 fistula cases were operated on, with over 80% of patients rehabilitated and reintegrated into society through skill development and livelihood opportunities.
The healthcare system received a further boost with the establishment of Fistula Corners in 35 district hospitals, supported by 30 active surgeons and 18 repair centers. In 2021, Panchagarh became the first district to be declared fistula-free, followed by nine upazilas across nine districts. Collaboration with the Ministry of Health and Family Welfare, other government partners, departments, NGOs, and the private sector has played a key role in driving these achievements.
The task ahead is still daunting with another 17,000 existing cases yet to be identified, operated, and rehabilitated, and 63 districts to be declared fistula free. Bangladesh has the potential to eliminate fistula by 2030, and, to succeed, the country must address root causes, overcome systemic barriers, and scale up proven interventions while optimizing resources. Key strategies must include a mission-driven approach to prevention, treatment, and rehabilitation.
For complex cases requiring advanced treatment, seamless referral systems are very important
Eradicating child marriage and adolescent pregnancy
Prevention is the most powerful tool in eliminating fistula. Addressing the root causes of child marriage and early pregnancy through education, law enforcement, and community engagement will significantly reduce the incidence of fistula. Keeping girls empowering them with knowledge about reproductive health can delay marriage and childbirth, protecting them from complications.
Community-based screening and awareness campaigns
Mobilizing mass screening campaigns, led by trained health workers and community volunteers are essential to identify hidden cases at the community level. Public awareness initiatives are equally vital in challenging deeply ingrained gender norms which perpetuate stigma and shame. By educating families about the availability of free treatment and fostering supportive environments, these initiatives empower women to seek help without fear of judgment, enabling them to regain their health and dignity.
Referral systems and advanced surgical management
For complex cases requiring advanced treatment, seamless referral systems are very important. Retaining skilled fistula surgeons and providing continuous training will ensure the quality and success of surgical interventions.
Holistic rehabilitation and community support
Recovery doesn’t end with surgery. Survivors need psychosocial counselling, livelihood opportunities, and community reintegration programs. Various stakeholders, local governments, NGOs, and community leaders must collaborate to support survivors and break the cycle of stigma and poverty.
Improving maternal healthcare services
Increasing access to skilled birth attendants and ensuring emergency obstetric care in all regions are critical. Expanding the deployment of midwives at the union level health facilities and strengthening healthcare infrastructure in remote areas will prevent prolonged labour and its complications. Fistula corners in district hospitals and upazila health complexes must be equipped to provide timely diagnosis and care.
Achieving a fistula-free Bangladesh requires a unified multi-stakeholder approach
Achieving a fistula-free Bangladesh requires a unified multi-stakeholder approach. Together, community health workers, medical practitioners, development partners, government and UN agencies must ensure no woman is left behind and suffer in silence.
Bangladesh’s Obstetric Fistula Program stands as a testament to what can and must be done to eliminate obstetric fistula. From December 11 through 13, Bangladesh will host the International Conference of Fistula Surgeons, bringing together over 500 participants from 35 countries, including 150 foreign delegates from health ministries, fistula surgeons, and development partners. This conference offers a unique opportunity for Bangladesh to showcase its achievements, build global partnerships, and outline a roadmap to end fistula by 2030.
Ending fistula is not just about healthcare -- it is about restoring dignity, breaking down barriers, and transforming the lives of millions of women and adolescent girls. There is a lot more to be done for a Fistula Free Bangladesh, and we cannot rest until and unless it’s eliminated.
Masaki Watabe is currently serving as the Representative Ad Interim for UNFPA in Bangladesh.