Table 2 Barriers to interventions aimed at the prevention of obstetric fistulas categorised by the three phases of delay

• Lack of awareness about health and preventive interventions

 ○ Ignorance among the villagers of the dangers associated with unsupervised delivery for women who are at risk

 ○ Negative experiences of other women at healthcare facilities

 ○ Illiteracy

• Lack of access to preventive interventions

• Lack of financial resources serve as a major disincentive to the use of modern health facilities

• Reluctance of women to be away from their homes for an undetermined period of time

• Language barrier, dependence on translation of a brochure into the reader’s native language

• Preventive strategies regarding birth plans are lagging

• Lack of infrastructures such as paved roads, piped water, and electricity.

 ○ Worsens accessibility during he rainy and harvest seasons

• Lack of transport

 ○ Large distances from the villages to healthcare facilities

• Lack of financial resources to pay for transport

• Lack of ambulance services and portable oxygen

• Limited referral systems i.e. when emergency transport isn’t available

• Perception, healthcare practitioners view women with fistulas as a ‘nuisance’ and ‘embarrassment’

 ○ Affects their attitude towards them and in turn the experience of the patient

• Limited services and manpower

 ○ Doctors are preoccupied with high-tech practices, leaving their units overwhelmed with obstetric emergencies

 ○ Overworked staff

 ○ Staff shortages and high attrition rates

• Lack of skilled healthcare providers

 ○ High staff turnover at maternity units which results in the loss of valuable skills and training investments

 ○ Absence of supervisory staff

• Lack of financial resources, which leaves the facilities rarely self-sufficient

• Lack of reimbursement for village practitioners

• Improper/ limited use of the partograph

 ○ Lack of essential supplies and equipment needed

 ○ Lack of training