The silence between her steps

The Silence Between Her Steps

In many villages across the world, silence is not the absence of sound it is the weight of what cannot be spoken. For Amina, the silence followed her everywhere. It clung to her clothes, her footsteps, and the space people left between her and themselves. She was only sixteen when her life split into before and after.

Before, she was known for her laughter, for the way she ran barefoot to school, for her dream of becoming a nurse. After, she became “that girl,” whispered about, avoided, and blamed.

Amina’s story is not unique. Across at least 800 communities worldwide, obstetric fistula continues to steal dignity from women and girls, often born not from medical accidents alone, but from gender-based violence, early marriage, sexual exploitation, and cultural silence around sexuality.

Amina was married off at fourteen. The decision was framed as protection, as tradition, as morality. Her consent was never asked for; her body was treated as currency, her future as negotiable. Pregnancy came quickly. Labor came painfully. But help did not.

For three days, she labored at home. The nearest health center was miles away, transport cost money, and elders insisted that “women have always given birth this way.” When the baby was finally delivered stillborn Amina survived. But something inside her had broken.

She did not understand why she could no longer control her body. Why the smell followed her. Why her husband stopped touching her. Why women stopped sitting near her in church.

This is how fistula hides in plain sight not just as a medical condition, but as a social sentence.

In another country, another girl, Grace, became a survivor of rape during a conflict. Her pregnancy was the result of violence, her labor unattended in a refugee camp. When she developed fistula, the shame was placed on her body instead of the crime committed against her.

Sexual violence, whether in war zones, homes, or institutions meant to protect, remains a silent contributor to fistula. Girls whose bodies are not fully developed are forced into sex, pregnancy, and childbirth long before they are physically ready. The result is damage that can last a lifetime.

Yet society often responds with blame.

“She was immoral.” “She tempted him.” “She should have known better.”

The language of sexual immorality is frequently weaponized against survivors, shifting responsibility away from perpetrators and broken systems. In truth, fistula is not a moral failure it is a human rights failure.

In many places, women with fistula are divorced, abandoned, or sent back to their parents’ homes. Some live in isolation for years, believing they are cursed. Others turn to dangerous coping mechanisms or lose the will to live, not because of pain alone, but because of rejection.

But where silence exists, so does resistance.

In a small clinic supported by volunteers, Amina met other women like her. Older women. Younger girls. Survivors of forced marriages, rape, neglect. For the first time, she heard the word fistula spoken without shame. She learned that what happened to her had a name and that it could be treated.

Surgery restored her body. Community restored her voice.

Healing, however, is more than medical. It requires dismantling the systems that allow fistula to persist:

Gender violence normalized as culture

Silence around sexual health and consent

Lack of access to skilled maternal care

Moral judgments that punish survivors instead of perpetrators

Ending fistula means confronting uncomfortable truths about how societies treat women’s bodies. It means teaching boys consent, protecting girls’ education, challenging child marriage, and investing in maternal health. It means recognizing that sexual “morality” cannot exist where coercion, violence, and inequality thrive.

Today, Amina speaks to other girls. She tells them that their bodies are not shameful. That pain is not punishment. That silence is not safety.

Her story joins hundreds of others across the world—each one a reminder that fistula is preventable, treatable, and unacceptable.

Until every girl can give birth safely, love freely, and live with dignity, the silence must be broken.

And the world must listen.