RESUMEN
BACKGROUND: Obstetric Fistula results from failure to manage obstructed labor in a timely manner; the failure can be attributed to many factors. Therefore, the study seeks to provide a better understanding of the circumstances surrounding the occurrence of Obstetric Fistula using the Three-Delays model. METHODS: Semi-structured interviews were conducted with 19 women living with OF. Study participants were recruited from the Dr. Abbu Fistula Center and the Fistula Re-integration Center in Khartoum, Sudan. Thematic analysis was used to analyze the study findings. The Three-Delays Model guided the analysis and discussion of these findings. RESULTS: The majority (11 out of 19) experienced more than one delay and six of the participants had all the three delays. Women were kept at home by midwives or family members for days until the baby was dead or the woman showed severe signs of complications. Many of the participants went through injurious vaginal labor which could have been prevented if they had had timely access to a caesarian section. CONCLUSION: In order to reduce the delays in seeking care, special attention must be paid to raising women's, husbands' and the community's awareness about danger signs that may arise before and during childbirth, the benefits of skilled birth attendance, and where and when to seek help. In addition, the provision of information regarding where to find Emergency Obstetric Care services and a birth preparedness plan would facilitate prompt care-seeking behavior. More resources must be allocated to strengthen the quality and coverage of reproductive health services.
Asunto(s)
Complicaciones del Trabajo de Parto/psicología , Parto/fisiología , Tiempo de Tratamiento , Fístula Vaginal/psicología , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Complicaciones del Trabajo de Parto/etnología , Aceptación de la Atención de Salud , Embarazo , Resultado del Embarazo , Investigación Cualitativa , Sudán/epidemiología , Fístula Vaginal/etnología , Adulto JovenRESUMEN
Obstetric fistula, a maternal childbirth injury that results in chronic incontinence, affects an estimated one million women in the global south. In the course of media and donor coverage on this condition, fistula sufferers have been branded as 'child brides' who, following the onset of their incontinence, become social pariahs and eventually find physical and social redemption through surgical repair. This narrative framing pits the violence of 'culture' against the potency of biomedical salvation. Based on over two years of ethnographic research at fistula repair centres in Niger and Ethiopia, this paper challenges this narrative and argues that most women with obstetric fistula remain embedded in social relations, receive continued familial support, and, unexpectedly, experience ambiguous surgical outcomes. This paper interrogates the existing logics of the fistula narrative that have had the unintended effects of obscuring global structural inequalities and diverting attention away from systemic health access reforms.
Asunto(s)
Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Complicaciones del Trabajo de Parto/etnología , Incontinencia Urinaria/etnología , Fístula Vaginal/etnología , Adolescente , Adulto , Antropología Médica , Etiopía , Femenino , Reforma de la Atención de Salud , Humanos , Masculino , Niger , Complicaciones del Trabajo de Parto/psicología , Complicaciones del Trabajo de Parto/cirugía , Embarazo , Autocuidado/psicología , Apoyo Social , Factores Socioeconómicos , Resultado del Tratamiento , Incontinencia Urinaria/etiología , Incontinencia Urinaria/psicología , Incontinencia Urinaria/cirugía , Fístula Vaginal/etiología , Fístula Vaginal/psicología , Fístula Vaginal/cirugía , Adulto JovenRESUMEN
INTRODUCTION AND HYPOTHESIS: Obstetric fistula, caused by traumatic delivery and patient lack of access to obstetric care, is an important public health concern in developing countries, particularly in Sub-Saharan Africa. This research focuses on the experience of women living with obstetric fistula in Burkina Faso as well as their reintegration into community after surgery. METHODS: This project was funded by the Mères du Monde en Santé (MMS) Foundation and conducted in collaboration with the Boromo Hospital. A qualitative approach based on grounded theory and using the principles of participative action research (PAR) was used with semidirected interviews prior to surgery and follow-up interviews 1-2 years after surgery directly in the women's village of origin. Thirty-nine participants were recruited between 2012 and 2015. RESULTS: The results point to circumstances leading to obstetric fistula development: poverty, gender inequality in terms of decision making, healthcare-system deficiencies, and lack of services for referral and treatment of this condition. Our results reinforce the knowledge about the social and psychological repercussions of fistula by exploring the concepts of gossips, shame and self-exclusion as powerful mechanisms of exclusion, but they also show that social support was conserved for several women through their journey with this disease. There was complete social rehabilitation within the community after surgery; however, persistent barriers in term of anxiety regarding obstetric future and economic insecurity were present. CONCLUSIONS: Early recruitment for surgery and prevention are the main objectives when attempting to reduce the impact of obstetric fistula and facilitate patient reintegration. Improvements in local and governmental public health policies are required.