Healthcare remote for most Pakistani women

Razia was 15 years old, partially blind but happy when her parents married her off to a young labourer called Zahid, oblivious to the tragedy and heartache that would scar the next three years.

The daughter of a poor farmer from Rahimyarkhan in Pakistan's populous central Punjab province, Razia was born with cataracts that could have been rectified with a simple operation.

But lack of healthcare in rural Pakistan condemned her to a life of shadows.

Today, as she props herself up in bed at the Koohi Goth Women?s Hospital, a charity-run clinic on the outskirts of Karachi, her eyes brim with tears at the memory of her short marriage to 23-year-old Zahid -- and what followed.

"Just a few months after our wedding, he was out riding a motorcycle when a truck hit him. He was killed instantly," Razia said through her tears.

After he died, Razia discovered she was pregnant, and hoped the baby would give meaning to her grief.

But the child was still-born after a horrific two-day labour supervised by a dai, or traditional midwife, whose lack of skills left Razia debilitated and outcast.

Shershah Syed, the doctor in charge of the Koohi Goth clinic, said: "The unskilled attendant caused complications during labour and in the end (Razia) delivered a dead baby after suffering huge damage to herself."

As a result of her experience in labour, Razia developed fistula, among the most crippling and humiliating health problems for women in the developing world.

"Fistula is caused by prolonged labour -- as the baby?s head presses against the lining of the birth canal, it perforates the wall of the rectum and bladder leaving the mother unable to control her excretory functions," Syed said.

The teenager became a social pariah.

"I was put in a secluded hut in the village where my ailing mother took care of me," Razia said.

With her fellow villagers believing her injuries and discomfort were God?s will, Razia spent the next 18 months in embarrassed agony, unaware that her condition was preventable and treatable.

Then one morning she heard about the clinic and began believing she could be cured.

Leaving her infirm mother and brother at home, Razia took a train to Karachi, 634 kilometres (400 miles) to the south, and found her way to the Koohi Goth Women's Hospital where she has spent the last six months.

-- Bad for all, but worse for women --

Now she needs just one final operation before she can resume a normal life.

"She will be a normal woman," said Syed, adding that once Razia returns home she will "set a precedent for millions of poor and downtrodden Pakistani females, who have little access to proper health facilities". 

According to the doctor, Pakistan and neighbouring Afghanistan have the highest rates of fistula in Asia. 

The UN Population Fund (UNFPA) blames the high rates on a lack of skilled midwifes and emergency obstetric care, as well as early marriage and teenage pregnancy, high fertility and restricted mobility for women. 

In Pakistan alone, fistula cases average 6,000 deaths a year, said Syed, adding that a woman dies in childbirth every 18 minutes. 

The UNFPA puts Pakistan's maternal mortality ratio at 553 per 100,000 live births. 

"The health facilities in Pakistan are below standard for everyone, but for women the situation is far more difficult mainly because of increasing poverty and inaccessibility to proper health facilities," Syed said. 

Ashrafi Begum, 25, comes from Gilgit, near Kashmir in northern Pakistan. She was married to Mohammad Akbar, a trader, 12 years ago. 

She became pregnant five years after the wedding but lost the baby and developed fistula. like Razia, thanks to an unskilled midwife. 

"My in-laws shut me away as if I was a leper for a year or so, and then my husband divorced me," she said. 

Her brother took her to Karachi, 2,100 kilometres (1,313 miles) away, and put her in hospital where she has received treatment and looks forward to resuming a normal, healthy life. 

"I am happy to see myself getting rid of the disease. But people like my ex-husband are totally unaware of this and punish women without realising that we have committed no crime." 

Officials at the clinic said they do a double job, complimenting the medical treatment with psychological counselling. 

"These victims come to us in extremely bad shape, depressed and have very low self-esteem, so it takes time to get them back to life through medical and psychological care," said Sarwan Kumar, a resident doctor. 

Razia said she would return home after doctors declare her healthy, but first she has another task to complete. 

"I'm now going to try and find another charity that can treat my eyes too," she said.