Catherine Tembo
Enipher Asani was only 15 years old when she was forced into marriage by her guardian over 10 years ago. The 24-year-old from Namwera village in Mangochi, southern Malawi, said prior to her marriage, her mother had relocated to South Africa in search of greener pastures.Enipher’s aunt repeatedly pressured her to get married, arguing that her peers were already settled with their spouses.
Enipher Asani, Fistula Survivor
“She also threatened to stop providing my basic needs, so I finally gave in to her demands and got married,” she said, tears rolling down her cheeks.
A couple of months after moving in with her husband, she had conceived her firstborn. Sadly, the then 15-year-old had a stillbirth. A couple of hours later, she was diagnosed with fistula.
Fistula?
According to the United Nations Population Fund (UNFPA), obstetric fistula is a hole between the birth canal and bladder and/or rectum. UNFPA says the condition is one of the most serious and tragic childbirth injuries caused by prolonged, obstructed labor without access to timely, high-quality medical treatment.
The condition leaves the affected women and girls with leaking urine, feces, or both. Statistics by the UN agency reveal that half a million women and girls in sub-Saharan Africa, Asia, the Arab States region, and Latin America are estimated to be living with fistula.
During an interview at Bwaila Hospital, where she had come to seek help, Enipher revealed that the birth injury left her with leaking urine.
“My surgery was undertaken two weeks ago for now the hospital is undergoing few tests to see if the wound is cured,” she said.
Patrick Nampandeni, Clinician at Bwaila, confirmed Enipher’s surgery. “She should be out soon when the tests are complete,” he said.
More than nine years after being diagnosed with obstetric fistula, continues to struggle with stigma and a range of health conditions. She uses old clothes in place of a diaper to manage the urinary incontinence.
The continuous flow of urine, she says, has left her with rashes on her inner thighs, while she also constantly suffers from Urinary Tract Infections (UTIs). Enipher is forced to change her clothes at least five times a day.
“If I fail to change, I always end up having flies buzzing around me,” Enipher said, who added that she no longer attends public events due to stigma.
The stigma and isolation have taken a significant toll on her mental health, leaving her hopeless and lonely.
Country Director for Bwaila Fistula Care Centre and obstetric gynecologist Margeret Moyo explained how fistula affects women and young girls.
“It is caused by women experiencing prolonged labor without access to medical care, early marriages, and pregnancies among girls and young women, and poor health infrastructure,” Moyo explains.
According to Moyo, Malawi reports 2,000 new cases of obstetric fistula every year. “The obstetric fistula survivors are exposed to stigma and discrimination, with teenage girls being the most affected,” she says.
Moyo blames the discrimination on a lack of awareness about the causes and treatment of obstetric fistula.
She observed, “Education would be key to addressing this problem. Girls need to know that pregnancy at an early stage has the potential to trigger fistula.”
Magret moyo
To address this, Moyo says Bwaila Hospital is working with the Ministry of Education to incorporate fistula sensitization awareness campaigns into their programs.
Dr. Moses Muocha, a mental health expert, says the impacts of obstetric fistula expose adolescent survivors to discrimination, stigma, and mental health breakdown.
“The problem is huge and needs urgent addressing including sensitization as its also threatening lives of patients with suicide,” he said.
No wonder facilities like Bwaila Fistula Center are not only there to service Enipher rather also there providing life changing surgeries and critical support to women and girls from across the country and beyond the borders to countries like Mozambique which unfortunately also seems to be straining the facility due to the influx of patients from neighboring countries.
Amidst anxiety and hope, these adolescents undergo treatment symbolizing a beacon of hope in their journey towards healing and restoration.
# Catherine Tembo, is a Malawian Journalist and fellow of Africa Foundation for Young Professionals’ 2025 Women in Journalism, Gender reporting fellow
