Effects of obstetric fistula on womanhood: The case of West Pokot County, Kenya
Musyoki, Geraldine Kalekye
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This study sought to explore the effects of obstetric fistula on womanhood and demonstrate how these effects shape the identities of afflicted women in West Pokot County, Kenya. The specific objectives of this study were: to explore the social construction of womanhood among the Pokot; identify perceived factors contributing to thedevelopment of obstetric fistula among women; determine the effects of obstetric fistula on womanhood in West Pokot County and assess the coping strategies adopted by afflicted women to cope or live with obstetric fistula among the Pokot. The study was guided by Judith Butler’s (1988) Performative Acts and Gender Constitution Theory. The theory was complemented by Lazarus and Folkman’s (1984) Transactional model of stress and coping, which emphasizes appraisal to evaluate harm, threat and challenges. The study used the phenomenological design to both quantitative and qualitative research. Purposive sampling was used to identify the study-site in West Pokot County, key-informants and women with repaired obstetric fistula. Snowball sampling identified women with unrepaired obstetric fistula while convenience sampling, was used to sample their spouses/care-givers. Guided questionnaires, interview schedules and observation check-list were used to generate data. Quantitative data was analyzed using descriptive statistics and is presented as percentages, tabulations and graphics. Qualitative data was analyzed and presented thematically. Findings from this study revealed that the affected women experienced a deep sense of loss that has a negative impact on their identity and quality of life. These losses were signified as failures of motherhood, reproduction, sexuality, identity and marriage. The analysis revealed that 88% of the affected women had never heard of the condition before diagnosis at a health facility. Misconceptions about the real causes of obstetric fistula were linked to cultural taboos and superstitious beliefs. Only 32% of the respondents could associate the condition with the immediate events of childbirth, while 53% thought it was incurable. The affected women at 77% had a high preference for non-skilled birth attendants during delivery away from health facilities, a factor that predisposed them to obstetric fistula. The women and their spouses/care-givers at 78% affirmed that obstetric fistula put a strain on their personal and sexual relationships. To cope with obstetric fistula, the women used among others, home-made paddings, frequent bathing, self-isolation, and limited food and water intake. The study recommends an intensive awareness on factors that predispose women to the occurrence and management of obstetric fistula and the potentially positive reproductive prospects after treatment. Prevention strategies must be community inclusive and participatory so as to build locally appropriate and acceptable solutions. Any efforts to reduce maternal mortality and morbidity, must focus on having a sound knowledge of the risk factors that predispose girls and women in Kenya to developing obstetric fistula; mass awareness and mobilization of the community on the condition; improvements in emergency obstetric care as well as the socio-economic status of women, their education and empowerment.