Barriers to Access Fistula Services: An Account of Fistula survivors and ambassadors in Mwanza, Tanzania

Abstract

Abstract Background Obstetric fistula is a leading cause of pregnancy-related disability and stigma for around one million women across developing countries. There are between 50,000 to 100,000 new fistula cases each year worldwide, with less than 15,000 cases treated annually(1). In Tanzania, around 3,000 new fistula cases develop every year, with an average of 1,300(2) cases treated annually. This study aimed at understanding the barriers women living with obstetric fistula in rural and urban settings face in accessing fistula treatment services in Tanzania. Methods This study used an explanatory sequential design that started with a quantitative study and then built on qualitative findings to understand the barriers women living with obstetric fistula in rural and urban settings face in accessing fistula treatment services in Tanzania. The multi-stage cluster sampling design was adopted to obtain the sample of 126 fistula survivors whereby the analysis used both quantitative and qualitative methods of data analysis; in quantitative analysis, the STATA version 14 was used whereby analysis was conducted on all 43 variables that were measured using the Likert scale. Qualitative information was audio recorded, transcribed, translated, and uploaded in Nvivo 10 for analysis. Results The study shows myths and misconceptions, stigma, low self-esteem, financial and transport challenges, fear and worries, and lack of social support and awareness of barriers hinder women in Tanzania to access timely appropriate fistula treatment services. The study revealed fistula survivors believed having a fistula was either a curse or caused by diabolic means. Fistula survivors reported being treated as outcasts and felt worthless because of isolation, the bad smell from continual leakage of urine and/or faeces; felt unclean, were ashamed of the condition, felt not complete as persons and were mistreated by their husbands. These made them anxious and depressed thus they did not want to travel to hospitals where they can get treatment. Conclusions Current and future fistula programming in Tanzania should consider targeted sustainable and consistent awareness creation that would address myths and misconceptions and other barriers related to awareness.