“I suffered for more than five years,” Sahara Abdi told me. Her eyes couldn’t hide the anguish she had endured, following her last pregnancy and delivery. Sahara’s place in the home and community changed completely, because of a birth complication called ‘obstetric fistula’.

Every year, thousands of women around the world are ostracized, banished by their husbands and ignored by their friends, because of this painful injury.

Sahara already had seven children. She had been through labor before. But in giving birth to her last child, Sahara’s labor became obstructed — the baby was lodged in the birth canal.


Women in this situation can remain in excruciating pain for several days, as they continue to labor, long after the baby has died. Too many woman are left with an obstetric fistula, a small hole between the laboring mother’s vagina and her bladder or rectum. The woman is left incontinent, with all the indignities that brings.

Lives devastated

In Canada, women whose deliveries are obstructed in some way receive emergency medical help, including a Caesarian section if needed. But when women live in remote places, or extreme poverty, this kind of medical care is not rarely available.

Sahara is from a nomadic family, living 400 km from the nearest hospital. She had no trained support person to help with her delivery.

The impact of a fistula can be nothing short of devastating. Women are unable to control their flow of urine or feces, sometimes, both. A woman is aware of the resulting odour, and she feels ashamed — often to the point of denying herself food and water to stem the flow. Malnutrition and dehydration can result.

Very often, a woman’s husband rejects her, and she’s forced to leave her home and children. Some fistula survivors are still girls, forced into pregnancy when their bodies were not developed or ready for it. They, too, are often cast aside.

Women with fistula are usually rejected, and are forced to live on their own.

No basic health care

Fistula is all-too-common in some of the world’s toughest places, regions without even the most basic health care. In Somaliland, for instance, many women have little or no access to the care they need — especially in rural regions.

Since fistula can’t heal by itself, this lack of basic health care before, during and after pregnancy can rob a woman of her life and family. Simple, effective care can make all the difference in many situations. A potential breech birth, for example, can be identified ahead of time in a basic pre-natal exam. The pregnant woman can then be transported to hospital for the delivery.

This health care must also happen in conjunction with advocacy work, to delay the age of marriage, and prevent rites of passage like female genital mutilation. Girls who become pregnant in adolescence are more likely to have small pelvises, as their bodies have yet to finish growing. And FGM narrows the opening through which a baby must pass, making obstruction far more likely.

Empowering women through healthcare

As a husband and father, it was almost unbearable for me to imagine what women like Sahara have endured. They emerge from the ordeal of excruciating childbirth. They are often also mourning the loss of a baby. Now, they bear the shame and deprivation of trying to live with the results of a fistula. Only to lose their families and homes, and live in isolation.

As I learned when visiting World Vision’s fistula hospital in Somaliland last month, the surgery to repair the condition is delicate, but fairly straightforward. Six hours later, a woman is opening her eyes on the next chapter of her life. I found this so encouraging, but I couldn’t help feeling angry that fistula happens to women who have already endured so much in their lives.

It would take so little for women to receive basic medical care that provides for their needs, especially during pregnancy, childbirth, and after childbirth. Fewer would endure the agony of living with fistula. It’s a powerful example of why access to inclusive medical care is so important in the journey toward gender equality and the realization of women’s rights.

At this hospital for fistula survivors, World Vision staff help care for women as they recover from surgery.

The fistula hospital in Borama, Somaliland, is filled with courageous women who are about to return to their homes and lives. The hospital, the only one of its kind in Somaliland, repairs fistula damage through a simple operation. The staff here treat 400 patients each year with free, life-changing surgery.

“The women smile again,” says Dr. Mumion Farah Ismail with a smile of his own. “It’s like they’ve come back to life.”

While the surgery Dr. Ismail performs offers women new hope, he admits this is only one small piece of what needs to be a more comprehensive health system — one that offers pregnant women and new mothers care of all kinds. That includes detecting, preventing and treating the complications that many women face.

Reaching the forgotten

Sahara is one of the few who now have a chance at a different life. After suffering for many years, her condition was diagnosed by a World Vision mobile health unit that was visiting her remote rural home, several days’ journey from the nearest hospital. Without that mobile clinic, Sahara may not have received the medical help she needed to restore her life.

Now, after a successful surgery, Sahara is nearly fully recovered. “I’m just so excited to go home,” she says, a huge smile brightening her face.

World Vision, along with other partners, provides the services at this fistula hospital in Borama. World Vision has recently built a new ward, allowing the hospital to care for more fistula survivors.

Learn how you can help empower families living in the world’s toughest places, through World Vision’s ‘Raw Hope’ initiative.

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