Risk and Resilience: Obstetric Fistula in Tanzania - EngenderHealth

Table 1: Overall Purpose of and Issues Explored in Each Type of Tool
Tool
In-depth interview on pregnancy
labor and delivery (girls and women)
In-depth interview on experience with
fistula (girls and women)
In-depth interview with family
members on labor, delivery, impacts,
and care-seeking behavior
Group discussions with providers and
community members
Problem trees with women with
fistula, family members, community
members, and providers
Freelisting and ranking with
community members
Overall purpose and issues explored
To understand factors related to women’s pregnancy, labor,
delivery, and post-delivery experiences with the pregnancy
that caused the fistula
To understand women’s experiences of living with fistula,
including impact and coping mechanisms
To understand family members’ perspectives on experiences
and care-seeking behavior related to the pregnancy that
resulted in the fistula, the impact of fistula on the family,
and coping strategies used by the family
To understand perspectives on socioeconomic, cultural, and
familial factors contributing to fistula
To understand root causes and beliefs about fistula and
coping strategies used to mitigate its impact.
To understand the three most important contributing factors
to maternal health complications during labor and delivery
Problem Trees on Obstetric Fistula
A problem tree is a participatory, learning and
action (PLA) visual tool that allows participants to
probe for the causes and consequences of a
particular issue. Participants draw a “tree” and
indicate the issue on the trunk of the tree. The roots
of the tree are then the causes of the problem and
the branches are the consequences of the problem.
Problem trees were carried out with women with
fistula, family members, community members, and
providers to understand beliefs about the causes
and consequences of fistula. Respondents were
asked the local names for fistula and how these
were interpreted locally and personally. This
exercise also explored the coping strategies used to
mitigate its impact.
Freelisting and Ranking Exercises on
Maternal Health Complications
Freelisting and ranking is a PLA tool where
participants brainstorm and list responses to a
particular question. Once this has been completed,
they then rank their responses in order of priority.
In this study, community members identified the
factors that contribute to maternal health
complications during labor and delivery and then
ranked them in order of importance. Additionally,
they were asked their opinions about the different
maternal health information and service needs of
women of reproductive age in their community
and their opinion of general health care services in
their community.
Group Discussions with Providers and
Community Members on Factors That
Contribute to Fistula
Group discussions were carried out with providers
and community members to understand their
perspectives on the socioeconomic, cultural, and
familial factors contributing to fistula. In addition,
they were asked their recommendations about
how fistula could be prevented.
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