Addressing the devastating impact of obstetric fistula through government programmes, UNFPA support, and community efforts to help women rebuild their lives and regain their dignity
As the sun dips over the fields of a remote village in Sunamganj in Bangladesh, 37-year-old Rokia Begum gathers eggs from her small poultry farm. Each egg feels like a promise -- a symbol of the life she's rebuilt. Not long ago, Rokia couldn't have imagined such a moment.
For years, Rokia, mother of six, lived in silence and shame, struggling with obstetric fistula, a childbirth injury caused by prolonged, obstructed labour without timely medical intervention. The condition left her incontinent, leading to constant leakage of urine or faeces, which made even simple daily tasks unbearable. "I couldn't go anywhere without fear," she recalls. The persistent odour and physical discomfort drove her into isolation. Her husband abandoned her, neighbours avoided her, and she became invisible in her community.
Rokia's story is shared by thousands of women across Bangladesh, where an estimated 20,000 women live with obstetric fistula. In rural areas, more than 35% of births still occur at home without skilled attendants. Child marriage and adolescent pregnancy exacerbate the issue, as young girls face a higher risk of obstructed labour. Despite progress in maternal healthcare, many women lack access to emergency obstetric care, leaving them vulnerable to this preventable condition.
Women with fistula often endure profound stigma and isolation, believing their condition is untreatable. "I thought this was my fate," Rokia admits. For women like her, a lack of awareness and accessible healthcare facilities creates a cycle of suffering and silence.
Rokia's life changed when a community health worker visited her village as part of the government's programme to end obstetric fistula. Thanks to training under the UNFPA-supported 'Global Campaign to End Fistula,' the community health worker was equipped to identify Rokia's symptoms and guide her to specialized care at a Fistula Corner. Encouraged by her family and local leaders, Rokia took a leap of faith and sought help.
At the hospital, she received surgery to repair the fistula that restored her dignity. "For the first time in years, I felt hope," she says. Following her surgery, Rokia joined a rehabilitation programme offering skills training and microloans to help women rebuild their lives. She chose poultry farming -- a trade she could manage from home while caring for her children.
Today, Rokia's farm is thriving. "I never imagined I could earn my own money," she says proudly, showing her chickens. Her newfound independence has transformed her role in the community. Neighbours who once shunned her now seek her advice, and she has become an advocate for maternal health, encouraging other women to seek treatment.
Rokia's recovery is one of thousands made possible through the collaborative efforts of the Government of Bangladesh and UNFPA under the National Strategy to Eliminate Obstetric Fistula by 2030. Through this partnership, UNFPA has trained healthcare providers, strengthened referral systems, and supported the establishment of Fistula Corners in 35 district hospitals. These facilities ensure that even women in remote areas have access to life-changing care.
"Many women suffer in silence because they don't know help is available," explains a community health worker. Since the programme's launch, health workers have identified thousands of cases, connecting women to treatment and rehabilitation. Between 2019 and 2023, over 3,000 women benefited from fistula treatment in Bangladesh, with 82% participating in rehabilitation programmes.
However, the task ahead remains significant. An estimated 17,000 women still live with untreated fistula, and 63 districts are yet to be declared fistula-free. To achieve its goal of eliminating fistula by 2030, Bangladesh must scale up proven interventions, address root causes like child marriage, and optimize resources to expand access to care.
For Rokia, the changes have been profound. She dreams of expanding her business and ensuring her daughters have opportunities she never did. "I want them to go to school, to dream bigger," she says.
Bangladesh's path to eliminating obstetric fistula by 2030 is within reach but demands sustained effort. UNFPA, through initiatives like the Global Campaign to End Fistula, continues to lead efforts to prevent and treat this condition. Supporting these programmes means restoring dignity and opportunities for thousands of women across Bangladesh.
"If I can rebuild my life, so can others," Rokia concludes. Together, we can make a fistula-free Bangladesh a reality -- one woman, one community, one story at a time.