Skip to main content

Childbirth experiences of women with obstetric fistula in Tanzania and Uganda and their implications for fistula program development

International Urogynecology Journal volume 22, pages 91–98 (2011)Cite this article

Abstract

Introduction and hypothesis

Authors sought evidence from the testimonies of women living with fistula regarding local risk factors for fistula and the impact of fistula on women's lives.

Methods

One hundred thirty-seven women recruited from health facilities and at the community level in Tanzania and Uganda were interviewed using quantitative and qualitative methods, including participatory approaches.

Results

Women of all ages and parities endured fistula. The testimonies illustrated that physical, socio-economic and cultural constraints, as well as health system failures, led to fistula, and the condition imposed harsh consequences on women's lives. Constraints included deficient maternal health services and personnel, delays in seeking and accessing care, and limited fistula repair services. Women endured severe social stigma and severe economic hardships.

Conclusions

Participants' testimonies expand current understanding of women's experience of fistula and point to recommendations that could improve maternal health care, reduce women's risk of fistula, and improve the lives of women living with the condition.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Pattinson RC, Hall M (2003) Near misses: a useful adjunct to maternal death enquiries. Br Med Bull 67:231–243

    CAS  Article  PubMed  Google Scholar 

  2. Uganda demographic and health survey 2006 (2007) Uganda Bureau of Statistics and Macro International Inc., Calverton, Maryland

  3. Population and housing census (main report) (2002) Uganda Bureau of Statistics, Kampala, Uganda

  4. National road map strategic plan to accelerate reduction of maternal and newborn deaths in Tanzania 2006–2010 (2007) Ministry of Health and Social Welfare, Dar es Salaam, Tanzania

  5. Status of emergency obstetric care (EmOC) in Uganda: a national needs assessment of EmOC process indicators (2003) Uganda Ministry of Health, Kampala

  6. Tanzania demographic and health survey 2004–05 (2005) National Bureau of Statistics and ORC Macro, Dar es Salaam, Tanzania

  7. Wall LL (2006) Obstetric vesicovaginal fistula as an international public-health problem. The Lancet 368:1201–1209

    Article  Google Scholar 

  8. Stanton C, Holtz SA, Ahmed S (2007) Challenges in measuring obstetric fistula. Int J Gynecol Obstet 99(Supplement 1):S4–S9

    Article  Google Scholar 

  9. AbouZahr C (1998) Prolonged and obstructed labor. In: Murray C, Lopez A (eds) The health dimensions of sex and reproduction: the global burden of sexually transmitted diseases and HIV, maternal conditions, perinatal disorders and congenital anomalies. Harvard University Press, Boston, pp 242–266

    Google Scholar 

  10. Weeks A, Lavender T, Nazziwa E et al (2005) Personal accounts of ‘near-miss’ maternal mortalities in Kampala, Uganda. Br J Obstet Gynaecol 112:1302–1307

    Article  Google Scholar 

  11. Mamdani M, Bangser M (2004) Poor people's experiences of health services in Tanzania. Reprod Health Matters 12(24):138–153

    Article  PubMed  Google Scholar 

  12. Urasa E, Massawe S, Lindmark G et al (1997) Operational factors affecting maternal mortality in Tanzania. Health Policy Plan 12(1):50–57

    Article  Google Scholar 

  13. Thaddeus S, Maine D (1994) Too far to walk: maternal mortality in context. Soc Sci Med 38(8):1091–1110

    CAS  Article  PubMed  Google Scholar 

  14. Arrowsmith S, Hamlin C, Wall L (1996) Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. CME Review Article, Obstet Gynecol Surv 51(9):568–574

    CAS  Article  Google Scholar 

  15. Danso KA, Martey JO, Wall LL et al (1996) The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992. Int Urogynecol J 7:117–120

    CAS  Article  Google Scholar 

  16. Villar J, Bergsjo P (1997) Scientific basis for the content of routine antenatal care: philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. Acta Obstet Gynecol Scand 76:1–14

    CAS  Article  PubMed  Google Scholar 

  17. Hilton P, Ward A (1998) Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years' experience in southeast Nigeria. Int Urogynecol J 9:189–194

    CAS  Article  Google Scholar 

  18. Johnson KA, Turan JM, Hailemariam L et al (2010) The role of counseling for obstetric fistula patients: lessons learned from Eritrea. Patient Educ Couns 80(2):262–265

    Article  PubMed  Google Scholar 

  19. Nathan LM, Rochat CH, Grigorescu B et al (2009) Obstetric fistulae in West Africa: patient perspectives. Am J Obstet Gynecol 200(5):e40–e42

    Article  PubMed  Google Scholar 

  20. Bangser M, Gumodoka B, Berege Z (2000) A comprehensive approach to vesico-vaginal fistula: a project in Mwanza, Tanzania. In: Berer M, Ravindran STK (eds) Safe motherhood initiatives: critical issues. Blackwell Science Ltd for Reproductive Health Matters, London, pp 157–164

    Google Scholar 

  21. Tanzania fistula survey 2001 (2002) Dar es Salaam: Women's Dignity Project

  22. Tanzania National Fistula Programme. Annual Report, 2007 Dar es Salaam: Women's Dignity Project, Ministry of Health and Social Welfare, African Medical Research Foundation

Download references

Acknowledgements

We thank all study participants, particularly the women with fistula who courageously shared their experiences of a highly stigmatizing condition. We also thank our many partners who assisted in carrying out this research: in Tanzania, Mary Zebron and Donko Francis Diu, Mary Rungwa and Maggreth Shaka from HAPA; Marrietta Mtumbuka and Barnabas Chipeta from Peramiho Mission Hospital; Yusta Ntibashima and Barnabas Solo from Kivulini; Alfreda Kabakama and Appolonia Makubi from Bugando Medical Center; and Simon Nkanda and Emili Kirako from Women's Dignity. In Uganda, Alice Emasu and Janneth Apugo from the Terrewode; Obed Kabanda and Louise Kabugho from the Good Hope Foundation; Annet Nangonzi, Adah Nkollenta and Regis Nansubuga from Kitovu Mission Hospital. From international organizations, Karen Beattie, Rachel Goldberg and Mary Nell Wegner from EngenderHealth; Malika Gujrati, Nicole Barber, John Lindsey, and Mevi Gray from the New School for Social Research; and Jennifer Harris Requejo with the World Health Organization.

Conflicts of interest

None.

Author information

Affiliations

  1. (Formerly) Women’s Dignity, PO Box 3503, Dar es Salaam, Tanzania

    Maggie Bangser

  2. Wellspring Advisors (formerly EngenderHealth), New York, NY, USA

    Manisha Mehta

  3. Warren Alpert School of Medicine, Brown University, Providence, RI, USA

    Janet Singer

  4. Queensland, Australia

    Chris Daly

  5. Women’s Dignity, Dar es Salaam, Tanzania

    Catherine Kamugumya

  6. Elizabeth Glazer Pediatric AIDS Foundation (formerly Women’s Dignity), Dar es Salaam, Tanzania

    Atuswege Mwangomale

Authors
  1. Maggie Bangser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manisha Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janet Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chris Daly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine Kamugumya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atuswege Mwangomale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maggie Bangser.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bangser, M., Mehta, M., Singer, J. et al. Childbirth experiences of women with obstetric fistula in Tanzania and Uganda and their implications for fistula program development. Int Urogynecol J 22, 91–98 (2011). https://doi.org/10.1007/s00192-010-1236-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-010-1236-8

Keywords

  • Maternal morbidity
  • Obstetric fistula
  • Tanzania
  • Uganda