Public Defence: Josephine Changole

Mphil Josephine Changole at Institute of Health and Society will be defending the thesis “The obstetric fistula pathway: Lived Experiences and Perspectives from Malawi” for the degree of PhD (Philosophiae Doctor).

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Trial Lecture – time and place

See Trial Lecture.

Adjudication committee

  • First opponent: Associate Professor Belinda Chimphamba Gombachika, University of Malawi, Malawi
  • Second opponent: Consultant (MD) Cathrine Reimers, Oslo University Hospital, Norway
  • Third member and chair of the evaluation committee: Associate Professor Elia Mmbaga, University of Oslo

Chair of the Defence

Professor Anne Cathrine Staff, University of Oslo

Principal Supervisor

Professor Jone Trovik, University of Bergen


Obstetric fistula is a devastating childbirth injury causing an abnormal passage between the vagina and the bladder (vesico-vaginal fistula) and/or the rectum (recto-vaginal fistula) resulting in urinary or fecal incontinence. The condition is primarily caused by a neglected, prolonged, obstructed labor and thus prevalent in low-income countries with poor obstetric service. This study aimed at exploring the lived experiences of women living with obstetric fistula in Malawi as well as the community knowledge and attitudes towards fistula suffereres.

A qualitative exploratory study using semi-structured in-depth interviews was conducted at Bwaila Fistula Care Center in Lilongwe and surrounding districts, including 25 women with obstetric fistula, 20 family members and 20 key informants, supplemented by 11 community members focus group discussions. The issues explored were labor leading to fistula formation, experiences of living with fistula and coping strategies, using the theoretical frameworks: Stigmatization, Three Delays Model, and the Transactional Model of Stress and Coping.

Findings indicate that women in Malawi still face challenges in accessing emergency obstetric care services due to delays at different levels. Anticipated stigma was more prevalent among women living with obstetric fistula but they demonstrated a great degree of resilience, using available resources to cope with their condition awaiting surgical repair. There was limited understanding about the real cause of obstetric fistula among community members, misconceptions and myths contributed to stigmatization of affected women. Hopefully increasing awareness of the three delays may lead the way for improved access to emergency obstetric care and fistula prevention. Public awareness about causes of obstetric fistula is required to minimize the anticipated/felt stigma.

Additional information

Contact the research support staff.

Published Feb. 4, 2020 5:51 PM - Last modified Feb. 6, 2020 9:29 AM