Sub-Saharan African Women’s Views and Experiences of Risk Factors for Obstetric Fistula: A Qualitative Systematic Review

Abstract Background: Obstetric fistula, also known as vesico vagina fistula (VVF), is a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labour. VVF may cause sufferers to experience chronic urinary and/or faecal incontinence, and the burden of continuing foul odour. Obstetric fistula is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or resolve the incidence of VVF. Objective: The objective of this review was to summarise what is reported about women’s own views and experiences of the risk factors underlying the causes of obstetric fistula. Methods: A systematic approach outlined in the Joanna Briggs institute Manual for Evidence synthesis was followed for this review, articles published within the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal checklist for qualitative studies. Results: Nine studies were retained for inclusion in this review, the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth).Conclusions. This review highlights the complexity of risk factors predisposing women to the known causes of obstetric fistula. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views and experience should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policy makers in Sub-Saharan Africa.