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Approximately
two million girls and women are estimated to be living with obstetric
fistula worldwide, yet fistula remains one of the most neglected issues in
women’s health and rights. It devastates lives, causing women, in most
cases, to lose their babies and to live with the humiliation of leaking
urine and/or feces constantly. Fistula also affects families: The
financial burden of paying for treatment and transport to hospitals,
together with the loss of one income-earner, places significant strains on
the families of girls and women living with fistula. Families also
suffer stress and worry about the impact of fistula on the girl or
woman. Examining fistula from the perspectives of girls and women
living with the condition provides vital evidence on how health care and
social systems often fail to meet women’s basic needs.
EngenderHealth and the Women’s Dignity Project have conducted
qualitative research in Tanzania to understand the many dimensions of
fistula and its related social vulnerability. This work explores the
experiences and views of girls and women living with fistula, as well as
those of their families and communities and of the health workers who care
for them. The study also explores participants’ recommendations on locally
appropriate solutions for preventing and managing fistula. Key findings
from the study include the following:
- Fistula affected girls and women of all ages, both at first
pregnancy and in later pregnancies. The median age at which women in the
study developed a fistula was 23. Fewer than half of the women were 19
or younger when the fistula occurred. In addition, about half of the
women were in their second or higher pregnancy.
- Antenatal care services, while widely available and used, were
inconsistent and inadequate. A majority of the women in the study
attended antenatal care services—nearly all of them at least twice—but
the services they received were inconsistent and inadequate and differed
greatly from Ministry of Health guidelines.
- The lack of birth preparedness, including basic information on
childbirth and on taking action around “the three delays,” increased the
risk of obstetric fistula.
- Nearly all of the girls and women in the study who began labor at
home made at least one move to get appropriate care, and a majority
faced multiple delays in reaching a facility with the needed services.
- Lack of access to emergency caesarean section posed a great threat
to women’s lives. For girls and women in the study, the most
commonly cited barriers to facility-based delivery were that they lacked
money and that the hospital was too far away. Nearly all of the women
who made a move during childbirth eventually got adequate care at the
hospital level and not at a peripheral-level facility.
- The cost and inaccessibility of high-quality fistula repair services
represented a barrier to care for many girls and women. Women and
their families who accessed fistula treatment sacrificed significant
amounts of time and money to do so, including selling assets to pay for
transport and treatment.
- Even though most women with fistula have support from others, the
emotional and economic impacts of fistula were substantial for the women
themselves, as well as for their families. For example, the majority of
girls and women said that they felt supported by another friend or
family member, but many also reported feeling the need to isolate
themselves out of shame.
You can view or download this report by clicking on the link below.
Several report briefs are also available:
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