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

From: Barriers and facilitators to preventive interventions for the development of obstetric fistulas among women in sub-Saharan Africa: a systematic review

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