Patient and practitioner perspectives: Obstetric fistula and healthcare access in Nigeria

Approximately 40% of the women with obstetric fistula (OF) reside in Nigeria. Obstetric fistula, a condition of continual urine and/or fecal leakage, usually results from prolonged, obstructed labor. Emergency obstetric care can prevent this debilitating condition.

With the objectives of decreasing this 40%, of enhancing quality of OF care, and of contributing to positive policy changes, a cross-sectional, ethnographic study at four regional OF treatment facilities in Nigeria was conducted.

Research methods were participant observation, interviews and focus group discussions. The sample was 140 respondents at four OF centers and fifteen governmental/non-governmental agencies in five States across Nigeria. Respondents included pre/post-operative fistula patients, clinicians, policy makers, and health professionals.

Study findings indicate that limited access to maternal healthcare is a systemic challenge that can cause OF. However practitioners and patients voice divergent reasons for what makes such access problematic in Nigeria. Most practitioners (47/50) believe that traditional childbirth practices and/or failure to deliver in a hospital are major causes of OF. Conversely, study participants cite failed attempts to access affordable healthcare and clinical mismanagement during their labour as main reasons for their fistula onset.  The vast majority (76/90) report visiting at least two health facilities before they finally delivered.

Patients’ childbirth experiences challenge dominant global health discourses that rely on conventional uses of culture to explain OF.  Coordinated, policy-based efforts to strengthen health workers’ ability to deliver quality, affordable maternal care and to holistically empower women’s access to these services will improve the health of Nigerian women and their children.