At 3:00 AM in 1985, 26-year-old ’Mathato* was already awake. Early mornings were a necessity in rural Lesotho back then, especially when a trip to the clinic in Mant’sonyane meant a grueling six-hour walk. She needed to leave before dawn to arrive by 9:00 AM.
But on this particular morning, as she prepared for the journey, her body signaled a different arrival. Her third child was coming.
What should have been a celebration quickly dissolved into a nightmare. ’Mathato’s baby was in a foot-breech position. Isolated and without professional medical intervention, she and a neighbouring woman fought for hours.
“The baby was stuck for a long time. Halfway through,” ’Mathato recalls, her voice dropping to a whisper. “I heard from those that were helping that my baby had died. He was finally born at around eight in the evening.”
Seventeen hours of agony had taken her baby’s life, and very nearly her own. “At that time, I was ready for the Lord to accept me,” she says softly. “I could see I was dying, and I had accepted it.”
’Mathato survived, but she was left with a devastating, lifelong injury: an obstetric fistula.
An obstetric fistula is a hole in the birth canal between the vagina and the bladder or rectum, caused by prolonged, obstructed labour. When a baby presses tightly against the mother's pelvis during obstructed labour, it cuts off the blood flow to the surrounding tissues. The deprived tissue dies, leaving a hole that results in the uncontrollable leakage of urine, faeces, or both.
For ‘Mathato, this began a 41-year sentence of physical and emotional torment.
Over the decades, she sought help at various hospitals. Reconstructive surgery managed to repair the damage to her rectum. "I can now at least control the faeces," she says. "But as for urine, I am still not able to control it."
She urges women to seek timely medical care and never attempt to give birth without the support of a skilled health professional.
When she can afford them, she uses adult diapers. When resources run dry, she resorts to old towels, which causes painful chaffing.
The physical pain of fistula is only half the battle. The social, psychological, and economic fallout is often worse. Because of the constant leakage, many women with the condition are cruelly ostracized by their own communities, friends, and even families.
“One of the things that hurt me the most,” ’Mathato shares, “is when people say there is a smell of urine when I am around.”
This deep stigma leads to profound social isolation and severe depression. It is a tragedy compounded by grief: in 90% of obstetric fistula cases, the baby does not survive the labour.
’Mathato’s story is heartbreaking, but it is not unique. Nearly half a million women and girls worldwide live with obstetric fistula, predominantly across sub-Saharan Africa, including Lesotho, Asia, and Latin America. It is a condition that speaks directly to gaps in maternal healthcare, poverty, and gender inequality.
Every year on May 23, the world marks the International Day to End Obstetric Fistula. Led by UNFPA, the United Nations sexual and reproductive health agency, this critical observance aims to raise global awareness and rally international action to eliminate the condition entirely by 2030.
For women like ’Mathato, awareness and medical intervention cannot come soon enough. Ending fistula is not just about a surgical fix; it is about restoring dignity, health, and a place in society to the world's most vulnerable women.
*Name has been changed to protect privacy.
