Few studies have been conducted on fistula in Tanzania and indeed on its relationship to home delivery. The general objective of this study was to examine the relationship between home delivery and fistula in Mufindi District. It also examined factors influencing home delivery and assessed women attitudes towards home delivery and also community awareness towards fistula.The study adopted cross-sectional research design where data were collected from 130 respondents through questionnaire survey interview, FGD and observations, checklist was used for key informant interview and FGD .The secondary information were collected from reviewing various literatures from Mufindi District office, Mufindi district hospital and other sources.Statistical analysis of data was done using descriptive statistics. Likert scale was used for attitude measure. Logistic regression was employed to get relationship for home delivery and fistula. The findings show that there is a direct relationship between home delivery and fistula, data showed 88.9% of fistula cases in Mufindi were home deliveries while 11.1% were hospital .The study shows that woman have negative attitude towards home delivery,61.9% disagreed than home delivery is safe,70% disagreed hospital midwives are very harsh,57.9% disagreed that experienced mothers has no need to deliver at hospital .Furthermore, the study shows that there is low community awareness of fistula in Mufindi as there was a lot misconceptions , about a relatively lower percentage of respondents were able to give the exact meaning of fistula and its causes. The study also finds poor timing, long distance to health facilities, poor roads ,unreliable transport, traditions and customs ,HIV tests, lack of decision making power ,costs of transport and other experiences ,number of child and experience from previous deliveries, were factors for home deliveries in Mufindi.