{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:43:40Z","timestamp":1787499820114,"version":"build-2736575974"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Obstetric fistula remains a debilitating complication of childbirth and maternal morbidity in developing countries. Few studies document the challenges and coping mechanisms among women living with obstetric fistula in Ethiopia. Therefore, this study aimed to explore the challenges and coping mechanisms among women with obstetric fistula in Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A phenomenological study was employed among purposively selected eleven women with obstetric fistula and three key informants at five fistula treatment centers in Ethiopia. An in-depth interview was conducted, audio-recorded, and transcribed into a Microsoft Word document. The transcripts were imported into Atlas. ti version 8.4 for thematic analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Painful social life, consequences of fistula, and coping mechanisms with fistula problems were the main themes in this study. Difficult social life, stigma, discrimination, impaired marital status; psychological, physical, sexual, and reproductive health problems were the major challenges for women with obstetric fistulas. Women with fistulas used coping mechanisms such as\u2014going to spiritual sites and drinking alcohol to cope with their fistula disease; separating themselves from community participation and living alone in the forest to cope with a painful social life; restricting the amount of drinking water and wearing many clothes at a time to cope with wetness and odors, and allowing their husband to marry a new wife to cope with the impaired marital responsibilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women with obstetric fistulas encountered challenges such as a painful social life, impaired marital status, psychological, physical, sexual, and reproductive health problems; and used coping mechanisms with their fistula condition, difficult social life, and impaired marital responsibility that may have an added negative effect on their overall health. Therefore, policymakers need to prioritize the availability and early utilization of obstetric fistula surgery in all settings for all women living with obstetric fistulas to restore their holistic health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0275318","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T15:22:46Z","timestamp":1664464966000},"page":"e0275318","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Challenges and coping mechanisms among women living with unrepaired obstetric fistula in Ethiopia: A phenomenological study"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8660-5275","authenticated-orcid":true,"given":"Bekana Fekecha","family":"Hurissa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zewdie Birhanu","family":"Koricha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lelisa Sena","family":"Dadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"issue":"4","key":"pone.0275318.ref001","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s00192-011-1622-x","article-title":"Risk factors for obstetric fistula: a clinical review.","volume":"23","author":"PM Tebeu","year":"2012","journal-title":"International urogynecology journal."},{"issue":"11","key":"pone.0275318.ref002","doi-asserted-by":"crossref","first-page":"e112299","DOI":"10.1371\/journal.pone.0112299","article-title":"Risk factors for obstetric fistula in Western Uganda: a case control study.","volume":"9","author":"JK Barageine","year":"2014","journal-title":"PLoS One.Nov 17"},{"issue":"8","key":"pone.0275318.ref003","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1111\/1471-0528.12739","article-title":"Prevalence of obstetric fistula: a population\u2010based study in rural P akistan.","volume":"121","author":"AH Jokhio","year":"2014","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"issue":"1","key":"pone.0275318.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1742-4755-10-14","article-title":"A population based survey in Ethiopia using questionnaire as proxy to estimate obstetric fistula prevalence: results from demographic and health survey.","volume":"10","author":"S Biadgilign","year":"2013","journal-title":"Reproductive health."},{"issue":"1","key":"pone.0275318.ref005","doi-asserted-by":"crossref","first-page":"4663","DOI":"10.4081\/hls.2015.4663","article-title":"Obstetric fistula in Assam, India: a neglected cause of maternal morbidities and mortality.","volume":"3","author":"S Jungari","year":"2015","journal-title":"Healthcare in Low-resource Settings."},{"issue":"1","key":"pone.0275318.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-015-0592-2","article-title":"Obstetric fistula in low-resource countries: an under-valued and under-studied problem\u2013systematic review of its incidence, prevalence, and association with stillbirth.","volume":"15","author":"KD Cowgill","year":"2015","journal-title":"BMC pregnancy and childbirth."},{"issue":"6","key":"pone.0275318.ref007","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1080\/17441692.2012.668919","article-title":"Maternal morbidity: neglected dimension of safe motherhood in the developing world.","volume":"7","author":"K Hardee","year":"2012","journal-title":"Global public health."},{"issue":"1","key":"pone.0275318.ref008","doi-asserted-by":"crossref","first-page":"60","DOI":"10.2471\/BLT.14.141473","article-title":"Measuring the incidence and prevalence of obstetric fistula: approaches, needs and recommendations","volume":"93","author":"\u00d6 Tun\u00e7alp","year":"2014","journal-title":"Bulletin of the World Health Organization"},{"issue":"1","key":"pone.0275318.ref009","first-page":"1","article-title":"Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis.","volume":"13","author":"AJ Adler","year":"2013","journal-title":"BMC pregnancy and childbirth."},{"key":"pone.0275318.ref010","doi-asserted-by":"crossref","first-page":"683","DOI":"10.2147\/IJWH.S306221","article-title":"Estimating the Prevalence and Risk Factors of Obstetric Fistula in Ethiopia: Results from Demographic and Health Survey.","volume":"13","author":"G Gedefaw","year":"2021","journal-title":"International Journal of Women\u2019s Health"},{"issue":"5","key":"pone.0275318.ref011","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.1016\/S2214-109X(15)70105-1","article-title":"Burden of obstetric fistula: from measurement to action","volume":"3","author":"S Ahmed","year":"2015","journal-title":"The Lancet Global Health"},{"issue":"5","key":"pone.0275318.ref012","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/S2214-109X(14)70348-1","article-title":"Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data","volume":"3","author":"M Maheu-Giroux","year":"2015","journal-title":"The Lancet Global Health"},{"issue":"1","key":"pone.0275318.ref013","article-title":"Clinical and Psychosocial Outcomes of Obstetrics Fistulae in Sub-Saharan Africa \u0101?? A Review of Literature","volume":"9","author":"TA Oluwasola","year":"2020","journal-title":"Journal of Basic and Clinical Reproductive Sciences"},{"key":"pone.0275318.ref014","unstructured":"Kimani ZM. The effects of obstetric fistula, impact and coping strategies of women in Kaptembwa\u2013Nakuru, Kenya. Doctoral dissertation, Egerton University. 2014. Available from: http:\/\/41.89.96.81:8080\/xmlui\/handle\/123456789\/1335."},{"issue":"4","key":"pone.0275318.ref015","doi-asserted-by":"crossref","first-page":"44","DOI":"10.24018\/ejmed.2021.3.4.844","article-title":"Social Features and Morbidity Patterns of Women with Obstetric Fistulae at an Obstetric Fistula Centre in a University Teaching Hospital in Jos","volume":"3","author":"A Ezekiel","year":"2021","journal-title":"Nigeria. European Journal of Medical and Health Sciences"},{"issue":"2","key":"pone.0275318.ref016","first-page":"055","article-title":"Birth and sorrow: the psycho-social and medical consequences of obstetric fistula.","volume":"2","author":"SB Baba","year":"2014","journal-title":"Int J Medical Sociol Anthropol"},{"issue":"1","key":"pone.0275318.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-015-0267-1","article-title":"Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania.","volume":"15","author":"LT Mselle","year":"2015","journal-title":"BMC women\u2019s health."},{"issue":"8","key":"pone.0275318.ref018","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1111\/1471-0528.15110","article-title":"Obstetric fistula: a paradigm shift is needed in research and prevention.","volume":"125","author":"P Letchworth","year":"2018","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"issue":"1","key":"pone.0275318.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-017-0451-6","article-title":"\u2018I stayed with my illness\u2019: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya.","volume":"17","author":"AM Khisa","year":"2017","journal-title":"BMC women\u2019s health"},{"issue":"2","key":"pone.0275318.ref020","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ijgo.2008.09.011","article-title":"Obstetric fistula in low-income countries.","volume":"104","author":"AX Zheng","year":"2009","journal-title":"International Journal of Gynecology & Obstetrics"},{"issue":"1","key":"pone.0275318.ref021","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3748\/wjg.v23.i1.11","article-title":"Fecal incontinence-Challenges and solutions","volume":"23","author":"NS Ruiz","year":"2017","journal-title":"World journal of gastroenterology"},{"key":"pone.0275318.ref022","unstructured":"Bakundane C. Knowledge, Attitude and Practice of Women Regarding Prevention of Obstetric Fistula at Kabale Regional Referral Hospita,Uganda.Doctoral dissertation, International Health Sciences University.2016. Available from: http:\/\/dspace.ciu.ac.ug\/handle\/123456789\/1064"},{"key":"pone.0275318.ref023","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.2147\/IJWH.S68382","article-title":"A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia.","volume":"6","author":"YT Gebresilase","year":"2014","journal-title":"International Journal of Women\u2019s Health"},{"issue":"1","key":"pone.0275318.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-018-0605-1","article-title":"Consequences of obstetric fistula in sub-Sahara African countries, from patients\u2019 perspective: a systematic review of qualitative studies.","volume":"18","author":"DT Bashah","year":"2018","journal-title":"BMC women\u2019s health."},{"issue":"1","key":"pone.0275318.ref025","first-page":"1","article-title":"\u201cThe sun keeps rising but darkness surrounds us\u201d: a qualitative exploration of the lived experiences of women with obstetric fistula in Ethiopia.","volume":"19","author":"M Animut","year":"2019","journal-title":"BMC women\u2019s health.Dec"},{"issue":"5","key":"pone.0275318.ref026","doi-asserted-by":"crossref","first-page":"342","DOI":"10.18415\/ijmmu.v5i5.531","article-title":"Living with Vesico-Vaginal Fistula at Jimma University Medical Centre: A Phenomenological Study.","volume":"5","author":"YM Ali","year":"2019","journal-title":"International Journal of Multicultural and Multireligious Understanding."},{"issue":"10233","key":"pone.0275318.ref027","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/S0140-6736(20)30816-3","volume":"395","author":"A. Green","year":"2020","journal-title":"Catherine Hamlin. The Lancet"},{"key":"pone.0275318.ref028","article-title":"Hamlin Fistula Ethiopia (1974-).","author":"P. Ciardullo","year":"2015","journal-title":"Embryo Project Encyclopedia"},{"issue":"1","key":"pone.0275318.ref029","first-page":"1","article-title":"Characteristics and repair outcome of patients with Vesicovaginal fistula managed in Jimma University teaching Hospital","volume":"16","author":"DA Sori","year":"2016","journal-title":"Ethiopia. BMC urology"},{"issue":"273","key":"pone.0275318.ref030","first-page":"2","article-title":"Comparison of Binary Models for the Associated Factors Affecting Recovery Status of Vesico-vaginal Obstetrics Fistula Patients: A Case of Mettu Hamlin Fistula Center, South West Ethiopian.","volume":"7","author":"A. Temesgen","year":"2016","journal-title":"Journal of Biometrics & Biostatistics."},{"issue":"2","key":"pone.0275318.ref031","first-page":"85","article-title":"Time-to-recovery from obstetric fistula and associated factors: The case of Harar Hamlin Fistula Center.","volume":"31","author":"S Hussen","year":"2017","journal-title":"The Ethiopian Journal of Health Development"},{"issue":"4","key":"pone.0275318.ref032","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization.","volume":"52","author":"B Saunders","year":"2018","journal-title":"Quality & quantity"},{"issue":"1","key":"pone.0275318.ref033","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/160940691000900103","article-title":"Understanding the processes of translation and transliteration in qualitative research","volume":"9","author":"K Regmi","year":"2010","journal-title":"International Journal of Qualitative Methods"},{"issue":"2","key":"pone.0275318.ref034","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology.","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative research in psychology."},{"issue":"3","key":"pone.0275318.ref035","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00192-017-3375-7","article-title":"Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the","volume":"29","author":"I Ouedraogo","year":"2018","journal-title":"Danja Fistula Center. International urogynecology journal"},{"issue":"1","key":"pone.0275318.ref036","first-page":"1","article-title":"Psychosocial experiences of subjects with vesicovaginal fistula: A qualitative study","volume":"6","author":"DN Nweke","year":"2017","journal-title":"Global Journal of Medicine and Public Health"},{"issue":"2","key":"pone.0275318.ref037","doi-asserted-by":"crossref","first-page":"253","DOI":"10.5114\/aoms.2010.13904","article-title":"Characteristics of obstetric fistulas and the need for a prognostic classification system","volume":"6","author":"A Karateke","year":"2010","journal-title":"Archives of medical science: AMS"},{"issue":"1","key":"pone.0275318.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-017-1604-1","article-title":"\u201cI am a person but I am not a person\u201d: experiences of women living with obstetric fistula in the central region of Malawi.","volume":"17","author":"J Changole","year":"2017","journal-title":"BMC Pregnancy and Childbirth."},{"issue":"1","key":"pone.0275318.ref039","first-page":"112","article-title":"Obstetric fistula\" disease\" and ensuing care: patients\u2019 views in West-Africa.","volume":"19","author":"N Maulet","year":"2015","journal-title":"African Journal of Reproductive Health"},{"issue":"40","key":"pone.0275318.ref040","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0968-8080(12)40661-9","article-title":"Still living with fistula: an exploratory study of the experience of women with obstetric fistula following corrective surgery in West Pokot, Kenya.","volume":"20","author":"AM Khisa","year":"2012","journal-title":"Reproductive health matters."},{"key":"pone.0275318.ref041","unstructured":"Gladys S. Lived experiences of women with obstetric fistula in the Wa Municipality.Doctoral dissertation, University of Cape Coast.2019. Available from: http:\/\/hdl.handle.net\/123456789\/4849."},{"issue":"3\u20134","key":"pone.0275318.ref042","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.aogh.2017.07.003","article-title":"Social experiences of women with obstetric fistula seeking treatment in Kampala, Uganda.","volume":"83","author":"M Meurice","year":"2017","journal-title":"Annals of global health."},{"issue":"1","key":"pone.0275318.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-019-0846-y","article-title":"\u201cI feel myself incomplete, and I am inferior to people\u201d: experiences of Sudanese women living with obstetric fistula in Khartoum, Sudan.","volume":"16","author":"SA Ahmed","year":"2019","journal-title":"Reproductive Health."},{"key":"pone.0275318.ref044","unstructured":"Abokaiagana AL. Experiences of Women with Obstetric Fistula in the Bawku East District of the Upper East Region,Ghana.Doctoral dissertation, University of Ghana. 2010. Available from: http:\/\/ugspace.ug.edu.gh\/handle\/123456789\/7256."},{"issue":"6","key":"pone.0275318.ref045","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1080\/07399332.2012.755981","article-title":"Lived experiences of Ghanaian women with obstetric fistula.","volume":"34","author":"PP Mwini-Nyaledzigbor","year":"2013","journal-title":"Health care for women international."},{"issue":"1","key":"pone.0275318.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-019-0781-7","article-title":"The loss of dignity: social experience and coping of women with obstetric fistula, in Northwest Ethiopia.","volume":"19","author":"DT Bashah","year":"2019","journal-title":"BMC women\u2019s health."},{"key":"pone.0275318.ref047","doi-asserted-by":"crossref","first-page":"5250843","DOI":"10.1155\/2018\/5250843","article-title":"The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia.","volume":"2018","author":"AA Mohamed","year":"2018","journal-title":"Obstetrics and gynecology international."},{"issue":"2","key":"pone.0275318.ref048","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/09540121.2020.1716934","article-title":"Meaning-making as a coping strategy among transgender women living with HIV in Indonesia","volume":"33","author":"NK Fauk","year":"2021","journal-title":"AIDS care"},{"issue":"5","key":"pone.0275318.ref049","doi-asserted-by":"crossref","first-page":"e0251274","DOI":"10.1371\/journal.pone.0251274","article-title":"Psychological, sociocultural and economic coping strategies of mothers or female caregivers of children with a disability in Belu district, Indonesia.","volume":"16","author":"GA Asa","year":"2021","journal-title":"PloS one."},{"issue":"6","key":"pone.0275318.ref050","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.","volume":"19","author":"A Tong","year":"2007","journal-title":"International journal for quality in health care"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T15:23:48Z","timestamp":1664465028000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275318"}},"subtitle":[],"editor":[{"given":"Nelsensius Klau","family":"Fauk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,29]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0275318","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,29]]}}}