Summary

Summary

After having her first child, Pakistani mother of six Kiran Sohail developed obstetric fistula.

A preventable but painful condition, obstetric fistula is a hole that forms between a woman’s birth canal and rectum or bladder, causing her to leak urine, feces or both. It’s mainly caused by obstructed labor and a lack of access to timely medical care.

In Pakistan, where many women from low-income backgrounds give birth without proper medical care, 5,000 new cases of fistula develop every year.

Although Sohail tried many times to get treatment for her condition, the doctors she saw at government clinics didn’t have the training to provide it. She was forced to live with obstetric fistula for eight years until finally receiving repair surgery in 2014, at the only local hospital offering the treatment for free.

Filed on behalf of Sohail and other petitioners, this petition successfully demanded that Pakistan’s government ensure women throughout the Sindh Province can get information about and affordable treatment for obstetric fistula.

About the case

About the case

The Center filed this public interest petition on July 6, 2015, demanding that Pakistan’s government take measures to prevent and treat obstetric fistula. It was the first case to recognize that the high number of obstetric fistula cases in Pakistan violated women’s rights under the Pakistan Constitution, including their rights to life and dignity.

The case was filed at the High Court of Sindh by the Center’s Legal Advisor Sara Malkani, on behalf of Sohail; Dr. Shershah Syed, a gynecologist providing fistula repair services; and Tehrik-e-Niswan, a Pakistani women’s rights organization.

The petition was developed through the Center’s South Asia Reproductive Justice and Accountability Initiative (SARJAI), a network of organizations, lawyers and legal experts working to advance reproductive rights throughout Asia. 

It asked the government to make sure that every district in Sindh could provide affordable treatment and information about obstetric fistula.

The petition also asked the High Court to tell the Sindh Maternal, Neonatal and Child Health Programme and the Sindh Department of Health to:

• Train and equip one gynecologist in every district hospital in Sindh to provide fistula repair surgery.
• Offer both basic and emergency care for pregnant women, based on a national health guideline called the National Maternal Newborn and Child Health Framework (NMNCH Framework).
• Make sure community midwives are trained and deployed across Sindh, in accordance with the NMNCH Framework.

The petition also demanded that the government comply with its international treaty obligations under the Convention on Elimination of All Forms of Discrimination Against Women and the International Covenant on Economic Social and Cultural Rights.

In February 2019, the High Court ordered the government to take action by setting up fistula repair centers throughout Sindh and hiring trained gynecologists at public hospitals in the province.

Enforcing the ruling

Enforcing the ruling

After the ruling, the Center monitored the implementation of the court order and found that it was still not being fully enforced.

Since the government was slow to act, an application was filed in August 2019, asking the Court to give further directions to make sure the order was fully carried out.

At the final hearing on December 15, 2021, the High Court closed the case after seeing that the government had made real progress.

This included:

• Training gynecologists in four fistula repair centers across Sindh to conduct fistula surgeries for free. These centers reported conducting 34 surgeries in 2020 and 2021.
• Equipping two hospitals in Sindh’s capital city of Karachi to provide fistula repair surgery, where 33 surgeries have taken place since 2020.
• Scheduling interviews for early 2022 to hire more gynecologists in government hospitals across Sindh.

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