Risk and Resilience: Obstetric Fistula in Tanzania - EngenderHealth

eported delay was “delay in transportation.” These
barriers are critical reasons why women who need
skilled assistance at delivery do not get the care they
need; poor women in rural areas are likely to be
disproportionately affected by the barriers.
Girls and women, particularly in rural areas, urgently
need access to emergency obstetric care provided
by trained health care workers. The financial and
logistical barriers to service must be eliminated.
5. The cost and inaccessibility of high-quality
fistula repair services represent a barrier to
care for many girls and women.
The majority of the women had lived with fistula for
two or more years. At the time of the interview, the
majority had already sought fistula repair or were
seeking treatment. Of those women who sought
repair, fewer than half went to only one facility.
A similar number went either to multiple places
(including traditional healers) or to the same facility
multiple times. Among all the women who sought
treatment prior to the interview, fewer than half had
a successful repair.
Of the women in the study who specified reasons
for not getting repair, the primary reason was
because they did not have the money to seek
treatment. Those women and their families who
accessed treatment had sacrificed significant
amounts of time and money to do so, including
selling assets to pay for transport and treatment.
High-quality fistula repair services must be
available and accessible to women at no cost or at
highly subsidized cost.
6. Even though most women with fistula have
support from others, the emotional and
economic impacts of fistula are substantial for
the woman herself, as well as for her family.
Although it is widely noted in the literature that
girls and women with fistula are emotionally and
economically vulnerable, this study adds critical
knowledge to understanding the shape these
vulnerabilities take. For example, the majority of
girls and women said that they felt supported by
another friend or family member, but many also
reported feeling the need to isolate themselves out
of shame. Additionally, girls and women
highlighted the enormous economic cost that
fistula can have on an individual and on her family,
because of the additional resources needed for her
care. There is often less income coming into the
family because the woman with fistula is forced to
leave the paid workforce due to the stigma of the
condition.
Advocacy, support, and reintegration efforts
should be instituted to reduce the emotional and
economic impacts of fistula.
Conclusion
A robust policy and set of interventions, backed by
high-level commitment, must be implemented to
reduce maternal death and disability in Tanzania.
The findings of this study, together with the
2004–2005 Tanzania DHS, provide evidence of the
barriers girls and women face in accessing quality
maternal and reproductive health care services.
Urgent action is needed to address these barriers
and to save the lives of girls and women in Tanzania.
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