Obstetric fistula in tanzania - EngenderHealth

Finding 3: The lack of birth preparedness,including basic information on childbirth andtaking action around ‘delays’, increases risk.The majority of women in the study had planned to deliver ata health facility of some type, although in the end nearly allstarted labor at home. A majority of the women interviewedfaced multiple delays in reaching a facility with the necessaryservice to enable them to deliver safely. The reason most oftencited for delays was that the woman or her family or friends didnot identify a problem that needed to be addressed by a skilledhealth provider.Fewer than half of the women had set aside some funds forcosts related to labor, delivery, post-delivery and/or transport.Thus, when problems emerged, the necessary preparationwas lacking.Recommendation: Concrete information on birth preparedness,that is understood and acted upon, is critical to avoid delays intime of emergency.Health care providers, women, and their families needcomprehensive information on birth preparedness to help intimes of emergencies. It must include the ‘danger signs’ thatindicate obstetric complications, the imperative to take quickaction when signs and symptoms of obstetric complicationsfirst present, and the importance of adequate planning toavoid delays in times of emergency (e.g., saving funds fordelivery-related expenses and arranging emergency transportplans). Traditional birth attendants and health workers inperipheral facilities (including lower level cadres) must alsohave this basic knowledge so that quick and proper referralscan be made to facilities with qualified medical personnel,supplies, and equipment to manage complications. Byunderstanding and swiftly acting upon complications arisingduring pregnancy and delivery, the risks of maternal andinfant death and injury, including obstetric fistula, can besignificantly reduced.Finding 4: Lack of access to emergencycaesarean section poses a great threat towomen’s lives.The most commonly cited barriers to facility-based deliverywere lack of money, and excessive distance to the nearesthospital. Yet, nearly all the women who did make a moveduring childbirth eventually got adequate care at the hospitallevel. The majority of the women incurred costs for transport,and a minority reported having to pay some type of fee forthe delivery.The 2004/5 Tanzania Demographic and Health Survey notesthat women do not have sufficient access to essentialmaternal health services including caesarean section. The2004/5 DHS also notes that “getting money for treatment”was the single biggest obstacle facing women seeking healthcare, followed by distance to the health facility and the needto take transportation. Striking differences were reportedbetween rich and poor women, and between urban and ruralwomen. Over half of the poorest quintile cited distance tofacility and the need to take transport as big problems. Incontrast, less than 20% of urban women and those from thehighest quintile encountered these problems [5].4