In Uganda, there are an estimated 200,000 women suffering from obstetric fistula, with
1,900 new cases expected annually. These figures, combined with a persistently high
maternal mortality rate, have led to an international discourse that claims the solution to
improving maternal health outcomes is facility-based delivery with a skilled birth
attendant. In accord with this discourse, the Ugandan government criminalized traditional
birth attendants in 2010. In this study, I examine the lived experience of traditional birth
attendants and women who have suffered from an obstetric fistula in eastern Uganda.
Using data collected from open-ended, semi-structured interviews, focus groups, and
participant-observation, I describe the biocultural determinants of obstetric fistula. Based
on findings, I argue that although emergency obstetric care is critical to prevent obstetric
fistula in cases of obstructed labor, the criminalization of the locally constructed system
of care, TBAs, serves as yet another layer of structural violence in the lives of rural, poor
women. Results demonstrate how political-economic and cultural determinants of
obstetric fistula are minimized in favor of a Western prescribed, bio-medical solution,
which is heavily resource dependent. This solution is promoted through a political
economy of hope fueled by the obstetric imaginary, or the enthusiastic belief in Western-style
biomedical obstetric care’s ability to deliver positive health outcomes for women
and infants regardless of local context and constraints. Recommendations include
increased obstetric fistula treatment facilities with improved communication from
medical staff, decriminalization of traditional birth attendants and renewed training
programs, and engaging local populations in maternal health discourse to ensure
culturally competent programs. / Graduation date: 2013
| Identifer | oai:union.ndltd.org:ORGSU/oai:ir.library.oregonstate.edu:1957/36140 |
| Date | 28 November 2012 |
| Creators | Ruder, Bonnie J. |
| Contributors | Cheyney, Melissa J. |
| Source Sets | Oregon State University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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