Perceptions and experiences of women seeking treatment for obstetric fistula.
OBJECTIVE
To understand patients' perspectives on the causative factors and preventive measures of obstetric fistula; and the effect of fistula on the victims' psycho-social, sexual, and economic well being.


METHODS
A questionnaire-based interview of 215 women with obstetric fistula admitted for treatment in 17 hospitals in India was carried out during 2010-2011. Responses of participants from poor, medium, and better performing states were categorized into pre-coded themes and compared.


RESULTS
The majority of the women were from rural areas (75.3%), multiparous (68.8%), and with less than high school education (82.2%). The majority (70.7%) of the women reported attempt at home delivery by untrained persons. Poor awareness of where and when to seek care when faced with a difficult delivery, and poor quality of care in facilities were perceived as important causative factors. Delivery by trained providers and early referral of women with problems during labor were identified as important preventive factors. Spouses and families were supportive of treatment in spite of economic hardships, but most (79.5%) patients felt socially isolated after developing fistula.


CONCLUSION
Poor awareness regarding delivery care among the women indicates a need for increasing birth preparedness in the community. Patients' perceptions of poor quality of care in facilities need to be addressed urgently. Psychological evaluation and counseling should be offered to fistula patients, to help them cope with adverse psycho-social and economic circumstances. The results of this study may provide insights for prevention and management of fistula, and may help to improve patient care and services.
['Singh|Shalini|S|0000-0002-8271-1062', 'Thakur|Tushita|T|', 'Chandhiok|Nomita|N|', 'Singh|Manish Kumar|MK|', 'Dhillon|Balwan Singh|BS|']
D000328:Adult D036861:Delivery, Obstetric D005260:Female D007722:Health Knowledge, Attitudes, Practice D006801:Humans D007194:India D011787:Quality of Health Care D011795:Surveys and Questionnaires D014624:Vaginal Fistula D055815:Young Adult
obstetric fistula home deliveries quality of care social isolation