Coventry University, Scarborough, UK.
Faculty of Health Sciences, University of Hull, Hull, UK.
Nurs Inq. 2020 Oct;27(4):e12377. doi: 10.1111/nin.12377. Epub 2020 Aug 30.
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 incidence 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.
产科瘘是由于分娩时间过长和受阻而导致阴道和直肠之间的异常开口。研究表明，产妇护理和家庭分娩的延迟导致瘘的发展。幸存者通常是社会经济地位较低的农村妇女。本研究通过在尼日利亚中北部的一个修复中心的叙事探究方法，探讨了 15 名瘘管幸存者的分娩经历。该研究使用结构暴力作为一个视角，描述了社会、政治和卫生系统在妇女获得医疗保健方面的不平等作用。对于选择家庭分娩的妇女来说，主要是由于缺乏资金、不完善的卫生系统和文化习俗，她们更倾向于在家分娩。农村地区的位置限制了妇女的获得机会，因为当出现并发症时，寻求设施分娩的妇女需要延迟转移到转诊中心。尼日利亚农村地区不平等的孕产妇保健服务与获得医疗保健服务密切相关，这导致瘘管发病率增加。结构性干预是一项卫生政策重点，旨在解决卫生系统不完善问题，并实现全民健康覆盖，以解决尼日利亚的孕产妇健康问题。
