Social Work & Obstetric Fistula
A CLOSER LOOK
A MICRO, MEZZO, AND MACRO
CULTURAL REVIEW
Obstetric Fistula (OF) has cause and risk implications across physical, social, financial, and transportation domains. Swain et al. (2019) emphasize the importance of timely care or a baby’s ability to be delivered by a cesarean section. Furthermore, the article details seven primary risk factors for OF, including the place of birth, presence of a skilled birth attendant, duration of labor, young age at delivery, older age, lack of family planning, and a variety of uncategorizable factors. Swain et al. (2019) also point out that women with OF tend to be impoverished and malnourished, and few have routine prenatal care. Baker et al. (2017) found that women experience barriers when seeking treatment because the procedure is too costly. Other financial delays are reported in the total cost of care at a facility, transportation costs, and maintenance for women and involved families.
MICRO
MEZZO
Social barriers were most frequently mentioned in Baker et al. (2017) system review, including stigma, embarrassment, and potential abandonment by the husband. Swain et al. (2019) describe how only half of the women in developing countries receive assistance from skilled attendants during delivery. Baker et al. (2017) add perceived poor quality of care is a barrier; although OF remains surgically treatable, surgery is not always successful. The article describes how even when the OF surgery is a success, women may experience incontinence for up to a few years. This may discourage some women from seeking care altogether. Baker et al. (2017) explain that facility shortages are the second most common barrier to OF treatment, encompassing staffing shortages of doctors, trained surgeons, facilities, equipment, and supplies. Baker et al. (2017) summarize that most women living with OF are from rural areas while most treatment facilities are in urban locations. If transportation is available or affordable, women may be in pain or discomfort or be turned away from public transit due to symptoms of obstetric fistula.
Macro findings reflect the impact of a male-controlled society, particularly access to healthcare and finances. Additional negative connotations with healthcare facilities and a preference for traditional care are seen across the literature review. Swain et al. (2019) identify that living in remote or rural areas without maternity care and skilled birth attendants is associated with OF. In developed countries, OF problems are less of an issue due to prenatal care. Swain et al. (2019) add that early marriage contributes to a risk; women with OF often marry as adolescents in remote areas and become pregnant before their pelvis are fully developed for childbearing, and many are undernourished. Several articles observe that child marriage directly impacts fistula rates; research indicates that people participating in child marriage practices are not fully cognizant of its adverse effects on women. “Consequently, newlywed girls are pressured to have children quickly as a means of proving their fertility and securing their status, and respect as an adult” (Lufumpa & Steele, 2016, p. 122).
MACRO
Baker, Z., Bellows, B., Bach, R., & Warren, C. (2017). Barriers to obstetric fistula treatment in low‐income countries: A systematic review. Tropical Medicine &
International Health, 22(8), 938–959. https://doi.org/10.1111/tmi.12893
Lufumpa, E. K., & Steele, S. (2016). Obstetric fistula: A narrative review of the literature on preventive interventions in sub-saharan africa. African Journal of
Reproductive Health, 20(3),118–126. https://doi.org/10.29063/ajrh2016/v20i3.16
Swain, D., Parida, S., Jena, S., Das, M., & Das, H. (2019). Obstetric fistula: A challenge to public health. Indian Journal of Public Health, 63(1), 73–78.