title: Healthcare access and quality of birth care: narratives of women living with obstetric fistula in rural Tanzania.
abstract: BACKGROUND
  Increasing births with skilled attendants and increasing health facilities with Emergency Obstetric Care (EmOC) can reduce maternal mortality and are considered critical interventions for ensuring safe motherhood. Despite Tanzania's policy to support women to give birth with the assistance of skilled personnel, some women do not access this care. This article uses women's stories to illustrate the challenges that caused them to fail to access adequate obstetric care in a timely manner, hence causing the development of fistulas.
  
  
  METHODS
  This paper presents the narratives of 16 women who were conveniently selected based on their experiences of not being able to access adequate obstetric care in timely manner. The analysis was guided by recommendations for the identification and interpretation of narratives, and identified important components of women's experiences, paying attention to commonalities, differences and areas of emphasis. Semi-structured interviews were carried out at CCBRT hospital in Dar es Salaam.
  
  
  RESULTS
  Four (4) general story lines were identified from women description of their inability to access quality obstetric care in a timely manner. These were; failing to decide on a health care facility for delivery, lacking money to get to a health care facility, lacking transportation to a health care facility and lacking quality birth care at the health care facility.
  
  
  CONCLUSIONS
  Women were unable to reach to the health care facilities providing comprehensive emergency obstetric care (CEmOC) in time because of their lack of decision-making power, money and transportation, and those who did reach the facilities received low quality birth care. Empowering women socially and financially, upgrading primary health care facilities to provide CEmOC and increased numbers of skilled personnel would promote health care facility deliveries.
authors.affiliation: Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, PO Box 65004, Dar es Salaam, Tanzania. nakutz@yahoo.com.
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Mselle
authors.affiliation: Department of Nursing Management, Muhimbili University of Health and Allied Sciences, PO Box 65004, Dar es Salaam, Tanzania.
authors.forename: Thecla W
authors.initials: TW
authors.lastname: Kohi
mesh_terms: D000328:Adult; D003657:Decision Making; D004632:Emergency Medical Services; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care; D012006:Rectovaginal Fistula / Q000517:prevention & control*; D012959:Socioeconomic Factors; D013636:Tanzania
keywords: Emergency obstetric care; Narratives; Obstetric fistula; Tanzania; Women’s birth care