Waiting for attention and care: birthing accounts of women in rural Tanzania who developed obstetric fistula as an outcome of labour

Abstract

BackgroundObstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour.MethodsWe used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza.ResultsWomen experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines.ConclusionsThis study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to accessible, acceptable and adequate quality services during labour and delivery.

Why do women not adhere to advice on maternal referral in rural Tanzania? Narratives of women and their family members

“…Mselle et al, studying women with obstetric fistulae in Tanzania, reported that decision to seek care in health facilities was reached when a complication had occurred [26]. The finding that more people are engaged when a woman is in labour, and especially when labour takes longer than normal, means that not only is the economic dimension important, but also the affection and symbolic dimensions of values of saving a life become important.…”

Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural Southern Malawi

“…A study in rural Tanzania showed that even at higher-level facilities where well trained health workers were supposed to be available, women experienced delays in receiving emergency obstetric care and had poor quality of care. Consequently, women experienced severe birth injuries and stillbirths [12]. When women have a choice, they will go to health facilities where they perceive better quality of care, regardless of distance [13,14].…”

Profiles and experiences of women undergoing genital fistula repair: Findings from five countries

“…Published accounts have found that many women and their families fail to recognise danger signs that necessitate skilled attendance at delivery or experience delays in seeking care due to lack of transportation or funds for transport; some experience delays once they reach the facility due to lack of providers, supplies, or equipment (Bangser et al, 2010; Holme, Breen, & MacArthur, 2007; Mselle, Kohi, Mvungi, Evjen-Olsen, & Moland, 2011a; Turan, Johnson, & Polan, 2007). …”