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. 2020 Jan 31;17(1):21.
doi: 10.1186/s12978-020-0860-0.

Obstetric fistula in southern Mozambique: a qualitative study on women's experiences of care pregnancy, delivery and post-partum

Helena Boene  1 , Sibone Mocumbi  2   3 , Ulf Högberg  4 , Claudia Hanson  5   6 , Anifa Valá  1 , Anna Bergström  4   7 , Esperança Sevene  1   8 , Khátia Munguambe  1   9
Affiliations

Obstetric fistula in southern Mozambique: a qualitative study on women's experiences of care pregnancy, delivery and post-partum

Helena Boene et al. Reprod Health. .

Abstract
in English, Portuguese

Background: Obstetric fistula is still common in low- and middle-income countries (LMIC) despite the on-going shift to increased facility deliveries in the same settings. The social behavioural circumstances in which fistula, as well as its consequences, still occur are poorly documented, particularly from the perspective of the experiences of women with obstetric fistula. This study sought to describe women's experiences of antenatal, partum and post-partum care in southern Mozambique, and to pinpoint those experiences that are unique to women with fistula in order to understand the care-seeking and care provision circumstances which could have been modified to avoid or mitigate the onset or consequences of fistula.

Methods: This study took place in Maputo and Gaza provinces, southern Mozambique, in 2016-2017. Qualitative data were collected through in-depth interviews conducted with 14 women with positive diagnoses of fistula and an equal number of women without fistula. All interviews were audio-recorded and transcribed verbatim prior to thematic analysis using NVivo11.

Results: Study participants had all attended antenatal care (ANC) visits and had prepared for a facility birth. Prolonged or obstructed labour, multiple referrals, and delays in receiving secondary and tertiary health care were common among the discourses of women with fistula. The term "fistula" was rarely known among participants, but the condition (referred to as "loss of water" or "illness of spillage") was recognised after being prompted on its signs and symptoms. Women with fistula were invariably aware of the links between fistula and poor birth assistance, in contrast with those without fistula, who blamed the condition on women's physiological and behavioural characteristics.

Conclusion: Although women do seek antenatal and peri-partum care in health facilities, deficiencies and delays in birth assistance, referral and life-saving interventions were commonly reported by women with fistula. Furthermore, weaknesses in quality of care, not only in relation to prevention, but also the resolution of the damage, were evident. Quality improvement of birth care is necessary, both at primary and referral level. There is a need to increase awareness and develop guidelines for prevention, early detection and management of obstetric fistula, including early postpartum treatment, availability of fistula repair for complex cases, and rehabilitation, coupled with the promotion of community consciousness of the problem.

Antecedentes: A fístula obstétrica continua a ser um problema de saúde comum em países de baixa e média renda, apesar das tendências de aumento dos partos institucionais nesses países. As circunstâncias socio-comportamentais em que a fístula ocorre, assim como suas consequências, são pouco documentadas, principalmente do ponto de vista das próprias mulheres com fístula obstétrica. Este estudo descreveu as experiências das mulheres em relação aos cuidados pré-natais, de parto e pós-parto no sul de Moçambique e identificou as experiências particulares das mulheres com fístula, a fim de compreender as circunstâncias em que a procura e oferta de cuidados poderiam ter sido modificadas para evitar ou mitigar a contracção ou as consequências da fístula.

Métodos: Este estudo foi realizado nas províncias de Maputo e Gaza, sul de Moçambique, em 2016–2017. Os dados qualitativos foram colhidos através de entrevistas em profundidade realizadas com 14 mulheres com diagnóstico positivo de fístula e um número igual de mulheres sem fístula. Todas as entrevistas foram gravadas em áudio e transcritas na íntegra para posterior análise temática utilizando NVivo11.

Conclusão: Embora as mulheres procurem cuidados pré-natais e peri-parto nas unidades sanitárias, deficiências e atrasos na assistência ao parto, referência e na indicação e aplicação de intervenções vitais foram experiências comumente relatadas por mulheres com fístula. Além disso, foram evidentes fragilidades na qualidade da assistência, não só em relação à prevenção, mas também à resolução dos danos. É crucial melhorar a qualidade da assistência ao parto, tanto ao nível primário como nos de referência. Existe a necessidade de aumentar a conscientização e desenvolver diretrizes para prevenção, detecção precoce e manejo da fístula obstétrica, incluindo tratamento pós-parto precoce, disponibilidade de reparo da fístula para casos complexos e reabilitação, juntamente com a promoção do conhecimento da comunidade sobre o problema.

Keywords: Mozambique; Obstetric fistula; Quality of care; women’s experiences.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Selection of the three groups of women who took part in the study
See this image and copyright information in PMC

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