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Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence

Degge, Hannah M.; Laurenson, Mary; Dumbili, Emeka W.; Hayter, Mark


Hannah M. Degge

Mary Laurenson

Emeka W. Dumbili

Mark Hayter


Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as, women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care; and these contribute to the increased incidences of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria.


Degge, H. M., Laurenson, M., Dumbili, E. W., & Hayter, M. (2020). Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence. Nursing Inquiry, 27(4), Article e12377.

Journal Article Type Article
Acceptance Date Jul 14, 2020
Online Publication Date Aug 30, 2020
Publication Date 2020-10
Deposit Date Jul 30, 2020
Publicly Available Date Oct 27, 2022
Journal Nursing Inquiry
Print ISSN 1320-7881
Electronic ISSN 1440-1800
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 27
Issue 4
Article Number e12377
Keywords obstetric fistula; structural violence; health systems; maternal health; narrative analysis; Nigeria
Public URL
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