This research explored the factors determining obstetric fistula development. It is mainly a case-controlled study analyzing the associations of maternal health conditions against road infrastructure and transportation services in Southern and Tigray regions of Ethiopia. Qualitative methods were used to explore the information in more detail to complement the quantitative methods.

Fistula patients who came to the Fistula Centers in Yirgalem and Mekele and pregnant mothers who came to deliver in Yirgalem and Mekele Hospital maternity units during the study period were enrolled to the study as cases and controls respectively. They were asked using structured questionnaires about the distance they have traveled, availability of transport and road infrastructure to reach the nearest hospital with caesarean deliveries. Health professionals and road authority officials were involved in focus group discussions and in-depth interviews.

Based on the assumption that 50% of women with obstetric fistula suffer from mobility problems, while only 25% in the control group face the same challenge, a total of 170 participants were enrolled in the study. There was a confidence interval of 95% and power of 80%. Economic status, delivery outcome, duration of labor, distance of participants’ home to health institutions, distance of their home to available all-weather roads and the availability of means of transportation were found to be significantly different among the cases and controls.
Fistula patients amount more than 72% (52/75) of the total illiterates, 50 out of 56 fistula patients lost their babies, only one fistula patient mentioned monthly income > or =300 Ethiopian Birr compared to 46 controls and more than 32% of fistula patients live more than 150 kms away from health institution with C/S facility compared to 7% of the controls.

Fistula patients of the various age groups and parity differ in their marital status, delivery outcome and place of delivery.
Although regional and central governments are aiming to improve access to different basic services, it is insufficient and hardly any inter-sectoral collaboration. To improve the existing developmental condition the government and sectors have to be committed and learn from others and adopt effective strategies appropriate for the Ethiopian context. Policy development and implementation should be done within the overall framework of achieving the Millennium Development Goals (MDGs).