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

Abstract

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.

Citation

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. https://doi.org/10.1111/nin.12377

• 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: Aug 31, 2021
• Journal: Nursing Inquiry
• Print ISSN: 1320-7881
• Electronic ISSN: 1440-1800
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 27
• Issue: 4
• Article Number: e12377
• DOI: https://doi.org/10.1111/nin.12377
• Keywords: obstetric fistula; structural violence; health systems; maternal health; narrative analysis; Nigeria
• Public URL: https://hull-repository.worktribe.com/output/3549790
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/nin.12377