Determinants of obstetric fistula in Afghanistan: An analysis of the Demographic and Health Survey 2015

Abstract

Objective To examine the reproductive, sociodemographic, and geographic factors associated with obstetric fistula, which is a significant but neglected health problem faced by women in low‐income countries, in women in Afghanistan, where epidemiologic studies examining the determinants of obstetric fistula are currently lacking. Methods This cross‐sectional study used data from a nationally representative sample of women collected through the Afghanistan Demographic and Health Survey 2015. Descriptive and binary and multivariable logistic regression analyses were performed to estimate the prevalence of obstetric fistula and describe and assess the risk factors associated with the condition. Results Among the weighted sample of 29 374 women aged 15–49 years, 3% reported having an obstetric fistula. In a multivariable logistic regression analysis, factors associated with women reporting a history of an obstetric fistula included parity, ethnicity, geography, income level, educational attainment, employment outside the home, decider on medical care, and their husband's education level. Conclusion Our findings highlight the multifactorial nature of the determinants of obstetric fistula in Afghan women and underscore the need for multidisciplinary integrative interventions to address the reproductive, socio‐economic, cultural, and healthcare‐related factors in reducing the burden of obstetric fistula in women in Afghanistan.

“I hope to all the world they don't forget women of Afghanistan”: An interrupted survey among doctors in Afghanistan

“…9 Studies based on the 2015 Afghanistan Demographic and Health Survey support that SRHR outcomes ranging from the rate of domestic violence, access to antenatal care, to the occurrence of obstetric fistula are associated with systemic challenges such as low literacy, lack of empowerment, and poverty. [10][11][12][13] This suggest that the consequences of too many pregnancies cannot be mitigated by one health initiative alone but requires a comprehensive approach including sexual education for girls and boys, the prevention of coerced or child marriage, informed contraceptive choice, the legal and structural prerequisites for safe abortion, counseling for rape, as well as antenatal, peripartum, and postpartum care including contraceptive counseling. Poverty reduction and sustainable development are intrinsically linked to SRHR through the provision of reproductive autonomy for women, usually resulting in smaller and more resourceful families.…”

“…A study from prior to the regime change identified similar structural barriers to access to care 9 . Studies based on the 2015 Afghanistan Demographic and Health Survey support that SRHR outcomes ranging from the rate of domestic violence, access to antenatal care, to the occurrence of obstetric fistula are associated with systemic challenges such as low literacy, lack of empowerment, and poverty 10‐13 …”