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Antenatal attendance was relatively high among cases but women still delayed in making the decision to seek delivery services.
However, the study did not evaluate the delay in making the decision to seek delivery services and in reaching health facilities.
This might encourage women to seek delivery services at the lower level facilities so that the higher level facilities focus more on complicated cases.
Our analysis identified having none or primary education, making decision to seek delivery services after six hours from onset of labour, and reaching a health facility after two hours as risk factors for developing obstetrics fistula.
Most studies have looked at the total duration of labour as opposed to the duration that lapsed between onset of labour and the decision to seek delivery services and or reaching health facilities.
One service user from Kanchanpur said: 'These days mothers-in-law in my VDC do not restrict their daughters-in-law to seek delivery services from the health facility'.
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She sought delivery services from a TBA and stayed two nights in the TBA's house writhing in labor pains.
Attendance by unskilled persons who did not recognise impending complications early enough to seek emergency obstetrics services could also contribute to delay in seeking delivery services [ 17].
Quality antenatal care and educating pregnancy women on importance of timely hospital delivery will reduce the delay in seeking delivery services.
Many husbands do not allow their wives to visit the health facility for seeking delivery services because of traditional beliefs although they have money and can manage transportation.
In Uganda, a study described that nurses abuse women without ANC cards and hinder their admission for delivery services; this deters women who did not use ANC from seeking delivery services [ 54].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com