Lack of awareness and sincerity of the caregivers as well as family members, around 71, 000 women are suffering from fistula, an obstetrical trauma and forced to live an inhuman life void of minimum love, care and support in her distressed physical and mental condition.

Prolonged and obstructed labour is the main reason of person's having fistula as due to prolonged pressure on the soft tissues in urinary bladder and rectum the blood supply is totally cut off resulting in decay of the muscles and tissues.

"Decaying start to take place after three hours of the obstructed labour. But we find women coming on 3rd to 6th days in critical condition. Most of the time, we have to bring out a decomposed baby and as soon as the baby is out it is seen continuous dribbling of urine or stool or both from the mother," said Ferdousi Begum, general secretary of Obstetrical and Gynaecological Society of Bangladesh (OGSB).

Per one thousand married women Fistula paralyses 1.67 in the country which is almost nil in developed country for improved maternal care, knowledge and awareness and adequate health service including skilled birth attendants.

Whereas 87 percent childbirth in the country is taking place by the unskilled birth attendants increasing the risk of the mothers' having fistula afterwards that crippled the women not only physically but also economically, socially and mentally.

" My husband who loved me very much started to scold and beat me as soon as I had been suffering from fistula and he even got marry to another one leaving me and my three year old child," said Dilara, a 19 year old lady with her tired voice who had been pushed to suffer from the disease with pain and stink bitterly for the negligence and un awareness of her family members.

"I tried to commit suicide even when the repeated reproach of my near and dear ones became unbearable only for this 'cursed disease'," she told.

"It is violence against motherhood and gross injustice as well. Propagation of generation is taking place through the women, yet they are uncared," said Prof Sayeba Akhter of Bangabandhu Sheikh Mujib Medical University (BSMMU) adding that the reasons behind one's getting fistula and its after effects towards a woman is injustice in all respects.

The disease is prevailing in the country silently and very few are aware of this maternal morbidity as the women who bear fistula while giving birth are socially outcast as the relatives still think it is the fault of the mother.

Fistula is more than a women's health problem. It typically affects the most marginalised members of society-poor, illiterate girls and young women living in remote areas. Root causes include early childbearing, malnutrition and limited access to emergency obstetric care. Even very few people know about the treatment of fistula though government has set up fistula centres in 8 medical colleges and a few of non government organisations have been also working on it.

Social awareness is a must as well as having skill birth attendants, said Prof Ferdousi adding that usually 80 percent delivery is normal while 15 percent see complication during this period and 5 percent need to go for caesarean.

" But in the country every year around four lakh delivery is taking place and it is not possible to manage 20,000 caesarean section for the pregnant mothers for lack of resources and manpower," she said adding that a mother is dying in every hour while giving birth and at the same time 50 mothers are becoming paralysed in different ways including fistula, incontinence, bladder infections, and genital ulceration.

Though a training programme to create skill birth attendants have started in 2003 in association with the government and OGSB, only 2,500 female family welfare and health assistants were trained. Whereas, it needs 28, 000 skilled birth attendants in the country, sources said.

The Bangladesh national estimate reflects that nearly 8.76 million women have been suffering from chronic morbidities like vesicovaginal fistula, recto vaginal fistula, uterine prolapse, dysparunia, hemorrhoids and associated physical and social disabilities.

Absence of a national survey on fistula patients also hinders to get the whole picture of prevalence of fistula and its severity.