Religious coping among women with obstetric fistula in Tanzania

Abstract

Religion is an important aspect of Tanzanian culture, and is often used to cope with adversity and distress. This study aimed to examine religious coping among women with obstetric fistulae. Fifty-four women receiving fistula repair at a Tanzanian hospital completed a structured survey. The Brief RCOPE assessed positive and negative religious coping strategies. Analyses included associations between negative religious coping and key variables (demographics, religiosity, depression, social support and stigma). Forty-five women also completed individual in-depth interviews where religion was discussed. Although participants utilised positive religious coping strategies more frequently than negative strategies (p < .001), 76% reported at least one form of negative religious coping. In univariate analysis, negative religious coping was associated with stigma, depression and low social support. In multivariate analysis, only depression remained significant, explaining 42% of the variance in coping. Qualitative data confirmed reliance upon religion to deal with fistula-related distress, and suggested that negative forms of religious coping may be an expression of depressive symptoms. Results suggest that negative religious coping could reflect cognitive distortions and negative emotionality, characteristic of depression. Religious leaders should be engaged to recognise signs of depression and provide appropriate pastoral/spiritual counselling and general psychosocial support for this population.

Keywords:

• obstetric fistula
• Tanzania
• religion
• gender
• maternal health

Acknowledgements

The authors would like to acknowledge institutional support from the Duke Global Health Institute and KCMC. This research would not have been possible without the following: the administrative help of Samwel Abado; the hard work of our data collectors, Haika Tarimo and Joyce Odondo; the assistance of the KCMC Obstetrics and Gynaecology residents, Damian Maruba, MD and Mberesero Joseph, MD; and the research participants who generously shared their time and insights. Academic guidance was provided by John Bartlett, MD, and Bernard Njau, MPH. Assistance with manuscript preparation was provided by Jennifer Velloza, MPH.

Funding

This work was supported by a small grant from the Duke Global Health Institute and a grant from the National Institute of Child Health and Development [R21HD073681, PI Watt].

Additional information

Funding

Funding: This work was supported by a small grant from the Duke Global Health Institute and a grant from the National Institute of Child Health and Development [R21HD073681, PI Watt].