Experiences of women with obstetric fistula in Nigeria : a narrative inquiry

Degge, Hannah Mafo

Health sciences
April 2018

Thesis or dissertation

© 2018 Hannah Mafo Degge. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. It occurs mostly in developing countries and is a neglected maternal health issue in Nigeria. Women’s experiences of living with fistula often reflect gender inequities. This study explored how women attending a reintegration service described their experiences of living with fistula. Using narrative inquiry methodology, 15 women (treated and rehabilitated) were interviewed. Data were analysed using the core story creation and emplotment method of narrative analysis. A reconstructed narrative provided plot headings of ‘fistula ordeal, treatment process, and returning to life’. Fistula formation was linked to the influence of others, geographical remoteness and transport and poor health systems. Fistula survivors and families facilitated access to treatment; aided to cope with incontinence that triggered stigma issues. Negative identity changes through incontinence were: ‘Leaking’ identity, ‘Masu yoyon fitsari’ (the leakers of urine identity), and ‘spoiled’ identity. Attending the repair centre conferred hope and relief through mutual survivors (‘Masu yoyon fitsari’) support. ‘Spoiled’ identity reflected the challenges of the ‘leaking’ identity in the face of ‘failings’ as a woman with respect to sexual and reproductive responsibilities. Reversing the negative identities was pivotal in the women’s resilience in seeking a cure. The ‘improved’ identity achieved after fistula repair and rehabilitation provided continence control and improved financial status. This research is the first known comprehensive empirical study of the experiences of treated and rehabilitated obstetric fistula survivors in Nigeria. The prevalence of fistula in Nigeria reflects inequitable distribution of health care compounded by socio-cultural practices. This research is the first application to women’s health in the African context using Frank’s narrative typology. The study contributes to the empirical evidence of women’s pathway through developing fistula, to treatment, and rehabilitation into family and community life in Nigeria.

Department of Health Studies, The University of Hull
Hayter, Mark (Professor of nursing and health research); Laurenson, Mary C.
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