Fistula treatment through surgery is reported to be successful in 80-90% of cases. Success in fistula repair has been defined by medical professionals in terms of clinical outcomes; beyond these definitions, it is important to understand how women perceive a positive clinical outcome and how it affects her family and home environment. This research was conducted in the Mangochi District of Malawi to answer these questions through interviews with women living with fistula and after surgical repair, as well as their partners and families. Over 104 interviews were conducted in June and October 2007. While eventually experiencing clinically successful surgical outcomes, women reported difficulty in seeking and receiving healthcare. Bureaucratic challenges were complicated by community misperceptions about the condition and fear of the healthcare system. Perspectives of women's families suggest that burdens and social disabilities caused by fistula extended beyond the individual to affect these family members. When women experienced surgical treatment, positive outcomes spread to her family and community. Positive experiences with the healthcare system turned women into advocates for healthcare in their communities. These findings illustrate that issues of obstetric fistula are not limited to individual women, but can dramatically affect their families, partners and communities.

This study from Southern Malawi reports on 407 patients with 408 vaginal fistulas (1 patient had 2 successive fistulas). There were 29 patients (7.6%) with a combined urogenital and recto-vaginal fistula. Obstructed labor was the cause of 379 fistulas and the remaining 29 were not of obstetric origin. Although the actual incidence of vaginal fistulas is unknown, the incidence is probably much lower in Malawi than in other African countries. The rate of closure at first repair was 94.1% for urogenital fistulas but it reached 98.5% overall. For recto-vaginal fistulas, closure at first repair was 78.8% but the overall rate of successful closure was 87.9%. Stress incontinence was seen in 16.2% of the patients immediately after repair and in 6.2% after 6 months. The latter rate is certainly too low, however, as 26 of 63 patients were lost to follow-up. A national fistula task force has been set up in Malawi.