Insights from birthing experiences of fistula survivors in North‐central Nigeria: Interplay of structural violence

Abstract

Obstetric fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour that can cause substantial, long-term physical and psychological harm to the woman (Bangser, 2006; Wall, 2006). The most common cause of fistula in developing countries is due to the obstruction of labour and delayed delivery (Wall, 2006). The inability of a woman to deliver her baby through the birth canal is caused by a discrepancy in the available space in the pelvic region and the foetal size or when the foetus' head or body is too big to pass through the mother's pelvis opening (Abrams, 2012; Wall, 2006). The obstruction leads to a prolonged pressured contact of the foetal head in the birth canal area, causing a loss of blood flow to the soft tissues of the woman's bladder, vagina and rectum (Arrowsmith, Hamlin, & Wall, 1996; Wall, 2012). Consequently, ischaemic injury leads to massive tissue necrosis in the woman's pelvis, which results in the fistula being formed (Wall, 2006). Numerous studies have described women with obstetric fistula as within the age range of 9-65 years, with the mean age usu

Sub-Saharan African Women’s Views and Experiences of Risk Factors for Obstetric Fistula: A Qualitative Systematic Review

“…Transportation is costly and unaffordable, or it is non-existent [38,44,45]. This nding is in line with that of HM Degge, M Laurenson, EW Dumbili and M Hayter [32], who described lack of transportation for women in labour as structural violence against women. L Barbi, M Cham, E Ame-Bruce and M Lazzerini [46] also implicated cost as a barrier to safe birthing environment and another reason for why women seek traditional birth attendants' services rather than birth in a health facility, is because women are asked to bring medical supplies or consumables that they cannot afford; in contrast TBAs require nothing but a white piece of cloth.…”

“…Three articles cited cultural beliefs and practices as a risk factor expressed by women for the cause of obstetric stula. [31][32][33].These articles reported cultural beliefs and practices impeded safe childbirth reporting outcomes including obstetric stula and foetal death.…”

“…Findings from seven studies highlighted this theme [4,31,32,[34][35][36][37] in which women expressed di culty in accessing health care facilities because of distance, poor roads, lack of nances and lack of suitable transportation (including delays in hire vehicles and/or lack of nances to hire a vehicle). For instance, one woman described her experience as follows: "The hospital is far therefore, it took some time to nd the money to rent a car to take me there, it took us a whole day to reach the hospital, on reaching the hospital, they put me up on the delivery table, but they told me that the baby had died'' [31].…”

“…We also found issues of lack of accessibility and social support for safe childbirth environments, as few women have either available means of transportation, support from husbands and relations in accompanying them to health institutions when they are in active labour, or the ability to afford medical supplies required by hospitals [16,31,32,36]. Transportation is costly and unaffordable, or it is non-existent [38,44,45].…”

“…Inexperienced birth attendant. Aggregation of ndings from three studies made up this theme[31,32, 36]. Women's previous encounters with inexperienced and neglectful healthcare providers during childbirth was cited as an indirect risk factor of VVF.…”