Obstetric fistula, an excruciating childbirth injury resulting in an abnormal connection between a woman’s birth canal and bladder or rectum, continues to haunt countless lives. Despite its profound impact, obstetric fistula remains largely unspoken, hidden in the shadows of societal taboos and healthcare disparities.

Within the Southeast Asian region, including Malaysia, reliable data remains elusive, making it challenging to ascertain the true prevalence of this condition. However, empirically, because of the access most women in Malaysia have to good healthcare facilities, obstetric fistulas are exceedingly uncommon in our country.

Globally, 65 percent of obstetric fistula cases occur in girls under the age of 18. It is a devastating childbirth injury afflicting the most impoverished and vulnerable girls and women. The physical, emotional, psychological, social, and economic consequences incurred by experiencing this condition at a younger age change their life forever and often face abandonment and ostracisation by the family, friends, and society.

The cause of obstetric fistulas lies in traumatic childbirth experiences. Prolonged and difficult labours subject women to prolonged pressure on the birth canal, resulting in inflammation, tissue damage, and death of cells. This can lead to the formation of fistulas, creating distressing symptoms such as urinary or faecal leakage, foul-smelling vaginal discharge, and chronic vaginal infections or painful sexual intercourse.

This injury results in extreme physical taboo and even isolation of the individual, which in turn results in emotional and mental burdens causing low self-esteem and depression. The long-term impact on intimate relations between a husband and wife exacerbate both physical and mental wellbeing of the woman too.

There are several contributing factors that heighten the risk of obstetric fistula:
 

• Limited Access to Skilled Healthcare
  Inadequate access to skilled birth attendants and emergency obstetric care are main determinants of obstetric fistulas. Prolonged labour without proper medical intervention can lead to severe birth trauma and fistula formation.
  
  
• Socioeconomic Challenges
  Poverty and lack of education initiate the burden of maternal health complications. Vulnerable populations are young women in underprivileged environments who may be subjected to childhood marriages, teenage pregnancies, and its complications which include fistula formation.
  
  
• Social Stigma and Cultural Barriers
  Some cultural beliefs and societal stigma surrounding childbirth-related injuries impede timely medical interventions. Misconceptions and shame prevent women from seeking the necessary healthcare, thus exacerbating the severity of obstetric fistulas.
  
  
• Limited Access to Treatment
  Limited trained healthcare professionals and resources for fistula repair poses a formidable obstacle to timely treatment. Inadequate healthcare infrastructure and surgical facilities prolong the suffering of affected women.