Determinants of Obstetric Fistula in Uganda: Evidence From the DHS data

Introduction Maternal mortality and morbidity remain a conspicuous and stark challenge to public health in developing countries. Each year, pregnancyrelated complications claim the lives of 500,000 women worldwide, with around 99% of these deaths occurring in developing countries (WHO 2005). Current best estimates indicate that for each woman who dies from pregnancyrelated complications, 15 to 30 women are seriously impaired and disabled from childbirth related complications in less developed countries. In subSaharan Africa alone, between 30,000 and 130,000 of women giving birth develop fistula each year (UNFPA 2008). Obstetric fistula is an extremely debilitating morbidity that occurs in situation of obstructed and prolonged labor resulting in an opening connecting the bladder and the vagina or connecting the bladder and the rectum, which leaves women with chronic incontinence of urine, feces, or both. The severe nature of obstetric fistula puts a serious toll in the lives of those affected by this condition. Most of the women who suffer from fistulas are often stigmatized; they experience acute social isolation stemming from the persistent odor due their incontinence (Wall 2006). Yet, despite the severity of this health condition, obstetric fistula has been less researched than female genital cutting in the field of reproductive health (Dejong 2005). Most of the published research on fistula in developing countries comes from clinical based studies (Wall 2006; Ramphal et al. 2007; Di Marco 2008), therefore limiting scope and broader generalizability. These studies are also largely descriptive and focus on fistula treatment and repair. Knowledge on the magnitude as well as on the characteristics of the women affected by the morbidity is still limited. Owing to the paucity of existing published research, this study aims to examine the determinants of obstetric fistula using the first round of data collected to study this topic from a population perspective, the 2006 Demographic and Health Survey (DHS) in Uganda.