Table 2.

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

Phase one: Decision to seek care	Phase two: Reaching a facility or preventive intervention	Phase three: Receiving adequate care through a preventive intervention
• 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