title: Childbirth experiences of women with obstetric fistula in Tanzania and Uganda and their implications for fistula program development.
abstract: OBJECTIVE
  authors sought evidence from the testimonies of women living with fistula regarding local risk factors for fistula and the impact of fistula on women's lives.
  
  
  METHODS
  one hundred thirty-seven women recruited from health facilities and at the community level in Tanzania and Uganda were interviewed using quantitative and qualitative methods, including participatory approaches.
  
  
  RESULTS
  women of all ages and parities endured fistula. The testimonies illustrated that physical, socio-economic and cultural constraints, as well as health system failures, led to fistula, and the condition imposed harsh consequences on women's lives. Constraints included deficient maternal health services and personnel, delays in seeking and accessing care, and limited fistula repair services. Women endured severe social stigma and severe economic hardships.
  
  
  CONCLUSIONS
  participants' testimonies expand current understanding of women's experience of fistula and point to recommendations that could improve maternal health care, reduce women's risk of fistula, and improve the lives of women living with the condition.
authors.affiliation: (Formerly) Women's Dignity, PO Box 3503, Dar es Salaam, Tanzania. bangser@gmail.com
authors.forename: Maggie
authors.initials: M
authors.lastname: Bangser
authors.forename: Manisha
authors.initials: M
authors.lastname: Mehta
authors.forename: Janet
authors.initials: J
authors.lastname: Singer
authors.forename: Chris
authors.initials: C
authors.lastname: Daly
authors.forename: Catherine
authors.initials: C
authors.lastname: Kamugumya
authors.forename: Atuswege
authors.initials: A
authors.lastname: Mwangomale
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services; D036801:Parturition; D011247:Pregnancy; D015995:Prevalence; D016730:Program Development; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000453:epidemiology* / Q000523:psychology*; D057545:Social Stigma; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D014719:Vesicovaginal Fistula / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult
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