Religious coping among women with obstetric fistula in Tanzania

BACKGROUND: Religion is an important aspect of Tanzanian culture, and is often used to cope with adversity and distress. This study examined the use of religious coping among women with obstetric fistula, a devastating consequence of obstructed labor that results in constant leaking of urine and/or feces. METHODS: 54 women admitted to a Tanzanian hospital for fistula repair completed a structured survey prior to surgery. R-COPE assessed religious coping, with positive and negative subscales. Analysis included descriptives and associations between negative religious coping and key variables (demographics, religiosity, depression, social support and stigma). A subset of 45 women also completed individual in-depth interviews where religion was discussed. RESULTS: The sample had an average age of 38, and had been living with a fistula for an average of 15 years. Two-thirds were Christian and one-third were Muslim. Although participants utilized 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 a multivariate stepwise regression, only depression remained in the model, explaining 45% of the variance. Qualitative data revealed perceptions of fistula as a punishment from God, and the close link between this perception and depressive symptoms. CONCLUSIONS: Results suggest that negative religious coping could reflect cognitive distortions, characteristic of depression. Religious leaders should be engaged to recognize signs of negative religious coping and provide appropriate pastoral/spiritual counseling and general psychosocial support for this population.