Sub-Saharan African women’s views and experiences of risk factors for obstetric fistula: a qualitative systematic review

Abstract

Background Obstetric fistula used as synonymous with VVF in this study, is an abnormal communication/hole between the urinary tract and the genital tract or the gastrointestinal tract and the genital tract, resulting from prolonged obstructed labour. VVF may cause sufferers to experience chronic urinary/faecal incontinence, and the stigma of continuing foul odour. VVF is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or prevent the incidence of obstetric fistula. Objective The objective of this review was to synthesise what is reported about women’s views and experiences of the risk factors underlying the causes of VVF. Methods A systematic approach outlined in the Joanna Briggs Institute Manual for Evidence synthesis was followed for this review, articles published since the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal Checklist for qualitative studies. Results Nine studies were retained for inclusion in this review and the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth). Conclusions This review highlights the complexity of risk factors predisposing women to the known causes of VVF. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views, and experiences should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policymakers in Sub-Saharan Africa.

Women’s views on obstetric fistula risk factors and prevention in north-central Nigeria: an interpretive descriptive study

“…Obstetric fistula can be surgically repaired, however recurrent fistula is common in the subsequent pregnancy 3 6. Obstetric fistula has several known contributing factors including birthing at home without a skilled birth attendant, delay in accessing intrapartum care, poor availability of emergency obstetric services, early adolescent pregnancy, poverty, and harmful traditional practices such as female genital mutilation, lack of formal education for girls and limited social empowerment for women 7–9…”

“…Obstetric fistula prevalence in Nigeria is estimated at 3.2 per 100 births and it is postulated that 13 000 new cases occur annually 8 11. In developing countries, women have limited decision-making power regarding where to give birth; rather the woman’s family, traditional birth attendants (TBAs) and community tend to be her decision makers 7 9. In northern Nigeria, lack of decision-making power is related in part to the practice of ‘Purdah’ which means some married women are not allowed to be seen by another man who is not her husband, which means they are unable to leave the home 7 8.…”

“…In developing countries, women have limited decision-making power regarding where to give birth; rather the woman’s family, traditional birth attendants (TBAs) and community tend to be her decision makers 7 9. In northern Nigeria, lack of decision-making power is related in part to the practice of ‘Purdah’ which means some married women are not allowed to be seen by another man who is not her husband, which means they are unable to leave the home 7 8. Many women also do not have any financial control and lack either the money to pay for healthcare utilisation during labour, or the power to use family money 7 12 13…”

“…In northern Nigeria, lack of decision-making power is related in part to the practice of ‘Purdah’ which means some married women are not allowed to be seen by another man who is not her husband, which means they are unable to leave the home 7 8. Many women also do not have any financial control and lack either the money to pay for healthcare utilisation during labour, or the power to use family money 7 12 13…”

Journey for a cure: Illness narratives of obstetric fistula survivors in North Central Nigeria

“…Obstetric fistula is uncommon in developed countries but remains a public health issue in Low‐ and Medium‐Income countries (Ahmed & Tunçalp, 2015; Ngongo et al., 2020; Wall, 2006). There, the condition is compounded by poor access to maternal health services amongst women of low socioeconomic status (Bulndi et al., 2022), such that it becomes a case of structural violence (Degge et al., 2020; Wall, 2012). Structural violence describes situations where unfavourable political and economic arrangements propagate societal inequalities, with the less privileged being brought into harm’s way (Farmer et al., 2006; Galtung, 1969).…”