Perceived Causes of Obstetric Fistula and Predictors of Treatment Seeking among Ugandan Women: Insights from Qualitative Research

Hadija Nalubwama, Alison M. El Ayadi, Justus K. Barageine, Josaphat Byamugisha, Othman Kakaire, Susan Obore, Haruna Mwanje, Suellen Miller


Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uganda. We explored women’s perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June–August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and children. Barriers to early treatment seeking included inadequate financial and social support, erroneous perceptions about fistula causes and curability, incorrect diagnoses, and delayed or lack of care at health facilities. Our study supports broad educational and awareness activities, facilitation of social and financial support for accessing care, and improving the quality of emergency obstetric care and fistula treatment surgical capacity to reduce women’s suffering. (Afr J Reprod Health 2020; 24[2]: 129-140).

Full Text:



UNFPA, EngenderHealth. Obstetric Fistula Needs

Assessment Report: findings from nine African countries. 2003.

Uganda Ministry of Health. National Obstetric Fistula

Strategy 2011/2012-2015/2016. Kampala: Uganda Ministry of Health; 2011.

UNFPA, Family Care International. Living Testimony:

Obstetric Fistula and Inequities in Maternal Health. 2007.

Kasamba N, Kaye DK and Mbalinda SN. Community

awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda. BMC Pregnancy Childbirth. 2013;13:229.

Uganda Bureau of Statistics and ICF International.

Uganda Demographic and Health Survey 2011. Kampala, Uganda and Calverton, Maryland: UBOS & ICF International Inc.; 2012.

Kabayambi J, Barageine J, Matovu J, Beyeza J, Ekirapa E

and Wanyenze RK. Living with obstetric fistula: Perceived causes, challenges and coping strategies among women attending the fistula clinic at Mulago Hospital, Uganda. Int J Trop Dis & Hlth. 2014;4(3):352-61.

Bellows B, Bach R, Baker Z and Warren C. Barriers to

Obstetric Fistula Treatment in Low-income Countries: A Systematic Review. Nairobi: Population Council; 2014.

Phillips BS, Ononokpono DN and Udofia NW.

Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria. Culture, health & sexuality. 2016;18(9):996-1009.

Uganda Ministry of Health. Campaign to end fistula:

Baseline Assessment of obstetric fistula in Uganda. 2003.

Woldeamanuel SA. Factors contributing to the delay in

seeking treatment for women with obstetric fistula in Ethiopia. South Africa: University of South Africa; 2012.

Baker Z, Bellows B, Bach R and Warren C. Barriers to

obstetric fistula treatment in low-income countries: a systematic review. Trop Med Int Health. 2017;22(8):938-59.

Centers for Disease Control and Prevention, National

Center for Injury Prevention and Control. The Social-Ecological Model: A Framework for Prevention. Atlanta, GA: Centers for Disease Control and Prevention; 2015.

Women's Dignity Project, EngenderHealth. Sharing the

Burden: Ugandan Women Speak about Obstetric Fistula. Dat es Salaam, Tanzania: Women's Dignity Project and EngenderHealth; 2007.

Wall LL. Overcoming phase 1 delays: the critical

component of obstetric fistula prevention programs in resource-poor countries. BMC Pregnancy Childbirth. 2012;12:68.

Anastasi E, Borchert M, Campbell OM, Sondorp E,

Kaducu F, Hill O, Okeng D, Odong VN and Lange IL. Losing women along the path to safe motherhood: why is there such a gap between women's use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda. BMC Pregnancy Childbirth. 2015;15:287.

Dahlberg M, Sodergard B, Thorson A, Alfven T and

Awiti-Ujiji O. Being perceived as 'a real woman' or following one's own convictions: a qualitative study to understand individual, family, and community influences on the place of childbirth in Busia, Kenya. Culture, health & sexuality. 2015;17(3): 326-42.

Sialubanje C, Massar K, Hamer DH and Ruiter RA.

Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study. BMC Pregnancy Childbirth. 2015;15:216.

Countdown to 2015. Country profiles 2015 [Available


Mselle LT and Kohi TW. Perceived Health System

Causes of Obstetric Fistula from Accounts of Affected Women in Rural Tanzania: A Qualitative Study. Afr J Reprod Health. 2015;19(1):124-32.

Okoye UO, Emma-Echiegu N and Tanyi PL. Living with

vesico-vaginal fistula: experiences of women awaiting repairs in Ebonyi State, Nigeria. Tanzania journal of health research. 2014;16(4):322-8.

Hildenwall H, Rutebemberwa E, Nsabagasani X, Pariyo

G, Tomson G and Peterson S. Local illness concepts--implications for management of childhood pneumonia in eastern Uganda. Acta Trop. 2007;101(3):217-24.

O'Neill S, Gryseels C, Dierickx S, Mwesigwa J, Okebe J,

d'Alessandro U and Grietens KP. Foul wind, spirits and witchcraft: illness conceptions and health-seeking behaviour for malaria in the Gambia. Malar J. 2015;14:167.

Tenkorang EY, Gyimah SO, Maticka-Tyndale E and

Adjei J. Superstition, witchcraft and HIV prevention in sub-Saharan Africa: the case of Ghana. Culture, health and sexuality. 2011;13(9):1001-14.

Wanyama J, Castelnuovo B, Wandera B, Mwebaze P,

Kambugu A, Bangsberg DR and Kamya MR. Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda. AIDS. 2007;21(11):1486-7.

Ahmed S and Holtz SA. Social and economic

consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet. 2007;99 Suppl 1:S10-5.

Velez A, Ramsey K and Tell K. The Campaign to End

Fistula: what have we learned? Findings of facility and community needs assessments. Int J Gynaecol Obstet. 2007;99 Suppl 1:S143-50.


  • There are currently no refbacks.