Risk and Resilience: Obstetric Fistula in Tanzania - EngenderHealth

fistula, and when his other daughter got pregnant,
he told her husband to send her to the mission
hospital before labor started.
Another set of parents blamed the medical
attendants 15 at the local dispensary, who had
examined their daughter earlier, since these
attendants could have identified and prevented the
problem.
G. Perceptions of Causes of Fistula
Women, their families, and community members
had different views about the causes of fistula, as
described in the following sections.
related to the delivery process itself. Fewer than
half of the women reported fistula to be caused by
a delivery delay. One woman stated, “If I had gone
to the hospital on time, I would not have fistula.”
(Woman from Ukerewe, age 28). Similarly, another
woman said, “I think I stayed in labor pain for a
long time and that caused the bladder to break.”
(Patient at Bugando, age 24) In addition, fewer
than half of the women attributed the fistula to
hospital procedures or to the provider. One
woman said, “I think they caused it because they
used instruments.” (Woman from Singida, age 18)
Another woman reported that her fistula problem
started after the doctors and nurses pulled out the
baby with delivery instruments.
“If I had gone to the
hospital on time, I
would not have
fistula.”
(Woman from Ukerewe, age 28)
Women’s Explanation of Fistula
According to findings from the in-depth interviews,
the majority of girls and women with fistula
believed their condition was caused by factors
Table 7: Women’s Perceptions of Causes of Fistula
Causes No. of women 16
Delivery-related procedures 32
Use of instruments during delivery 9
Provider’s fault 8
Woman afraid of pushing 6
Insertion of hands in the vagina by 5
provider/family and friends during labor
Operation (caesarean section) 4
Delivery delay 27
Delayed/prolonged delivery 14
Delay in reaching the hospital 12
Delay in getting a caesarean section 1
Bewitched 16
Fewer than half of the women perceived
bewitchment to be a cause of fistula. A woman
from Singida believed that she was bewitched
because she used to deliver on her own, without
the help of TBAs. She believed that the community
members and TBAs hated her because she denied
the TBAs the gifts and other privileges they get for
helping women deliver. A few women believed
that their fistula was the result of people inserting
their fingers into the vagina during labor. Some of
the other reasons given by women as causes of the
fistula included: the baby was too big; the woman
was scared to push during labor; it was God’s will;
and it was bad luck.
The group discussions and
problem trees among
women with fistula
confirmed these findings,
though less emphasis was
given to problems during
delivery itself and more to
delays in getting emergency
care. Not delivering at health
care facilities, living far from
the hospital, not having the
means to go to the hospital,
and being hesitant to go to
the hospital because of
traditional beliefs were all
listed as precursors to
getting fistula. Also
mentioned were being
bewitched, using traditional
15 Attendants at the local dispensary are generally untrained providers.
16 Some women provided multiple responses.
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