Abstract:
BACKGROUND: Obstetric 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.
METHODS: We 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.
RESULTS: Women 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.
CONCLUSIONS: This 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.
