The changing perception and knowledge of obstetric fistula: a qualitative study
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ORIGINAL ARTICLE
The changing perception and knowledge of obstetric fistula: a qualitative study Chi Chiung Grace Chen 1 & Jie Jiao 2 & Gerard Mbabazi 3 & Annelise Long 1 & Rachel Galvao 1 & Denis Rwabizi 3 & Blaise Dushimiyimana 3 & Eugene Ngoga 4 Received: 15 April 2020 / Accepted: 14 July 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis To describe the knowledge and perceptions of obstetric fistula (OF) among affected and unaffected women. Methods Twenty-five semi-structured interviews were conducted with women who had received OF repair. Three focus groups were conducted: one group of women with urinary incontinence but no OF, one group of women with OF, and one group of women without genitourinary complaints. Interviews and focus groups were conducted using the grounded theory approach. This study took place in two urban hospitals in Rwanda from April to November 2015. Transcripts were coded using MAXDA11 and analyzed using the axial technique and the constant comparative method. Results Nearly all participants correctly described OF and its symptoms, and 93% of interviewed women attributed OF to complications in vaginal delivery or cesarean section. Several participants described renouncing stigmatizing beliefs after learning about OF from the radio, health workers, or word of mouth. Still, it was found that women with OF were more knowledgeable about OF etiology than women without genitourinary conditions. Conclusions Compared to prior studies, women’s knowledge about OF appears to be more medically based, with media and health workers playing a role in reducing stigmatizing beliefs. These findings support continued investment in OF awareness campaigns, which seem to be increasing knowledge about OF and reducing stigma. Keywords Knowledge . Obstetric fistula . Perception
Introduction Obstetric fistula (OF) is a devastating but often preventable complication of childbirth. Prolonged or obstructed labor can damage the birth canal, resulting in an opening/fistula between the vagina and the lower urinary tract or between the
* Chi Chiung Grace Chen [email protected] 1
Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, 301 Building room 3118 4940 Eastern Ave, Baltimore, MD 21224, USA
2
Department of Obstetrics & Gynecology, Wayne State University/ Detroit Medical Center, Detroit, USA
3
Department of Obstetrics & Gynecology, University of Rwanda, Kigali, Rwanda
4
Rwanda Society of Obstetricians and Gynecologists, Kigali, Rwanda
vagina and the rectum/anus that leaves women incontinent of urine, feces, or both. While a rare complication in higher income countries, OF remains a public health problem in lower resource settings throughout Sub-Saharan Africa and South Asia. The World Health Organization (WHO) estimates OF affects 2–3.5 million women worldwide with an estimated annual worldwide incidence reaching between 50,000– 100,000 women [1, 2]. In more marginalized, remote regions of the world where women tend to deliver at young ages,
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