Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria

Cult Health Sex. 2016 Sep;18(9):996-1009. doi: 10.1080/13691058.2016.1148198. Epub 2016 Mar 9.


Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women.

Keywords: Nigeria; obstetric fistula; patient perspectives; professional perspectives.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Delivery, Obstetric*
  • Female
  • Fistula*
  • Grounded Theory
  • Health Personnel / education
  • Health Personnel / psychology*
  • Health Services Accessibility*
  • Humans
  • Interviews as Topic
  • Maternal Health Services / statistics & numerical data
  • Mothers / psychology*
  • Nigeria
  • Obstetric Labor Complications / mortality
  • Pregnancy
  • Pregnancy Outcome
  • Qualitative Research