Risk and Resilience: Obstetric Fistula in Tanzania - EngenderHealth

VII. Findings and Recommendations
Fistula provides a critical lens onto the health care
and social systems that can promote - or limit - the
capacity of girls and women to achieve well-being.
Underlying the medical presentation of fistula are
its true determinants: poverty, which constrains
families from accessing basic health services;
resource limitations, which undermine the capacity
of workers to deliver high-quality health care;
insufficient investment in infrastructure, which
makes transport to a health care facility nearly
impossible, particularly in an emergency;
insufficient access to information and knowledge
about maternal health and pregnancy-related
emergencies; inadequate education and decisionmaking
status for girls and women; and a
continuing acceptance of women’s dying in
childbirth or surviving with unspeakable
consequences.
at relatively younger ages (e.g., 15 and below), it
is likely that a higher proportion of fistula patients
are young and primigravida.
This study brings to light a range of findings on
fistula and social vulnerability. The findings are
based on the experiences and perspectives of 61
girls and women living with fistula, their families,
community members, and local health care
providers. The study dispels some long-held views
about those who live with fistula and provides
evidence for building locally appropriate solutions
to address fistula, and maternal mortality and
morbidity overall. Finally, the study establishes a
call to policymakers, health care workers, donors,
and communities to take action on women’s
health and women’s lives.
Following are six major findings of the study, with
corresponding recommendations:
Finding 1: Fistula affects girls and women of
all ages, both at first pregnancy and in later
pregnancies.
The median age at which girls and women in the
study sustained a fistula was 23. Fewer than half
were 19 or younger. In addition, about half were in
their second or higher pregnancy. These findings
challenge the general portrayal of fistula as a
condition affecting largely adolescent girls in their
first pregnancy. The reason for this may be
differences in age at sexual debut: In countries in
which girls get married and/or become pregnant
Recommendation 1: Policies and programs
addressing fistula need to expand beyond
currently held views that fistula largely affects
young girls. Public education and interventions to
mitigate the risks of fistula must address the full
reproductive life cycle of girls and women.
Conventional wisdom holds that very young girls
and those having their first delivery are most at
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