Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming

Abstract

Despite growing recognition of the importance of linking obstetric fistula prevention and treatment strategies with rehabilitation and social reintegration programmes, little research and programming has been oriented toward this goal. Using in-depth interviews, this study aimed to examine the experiences of 51 Ethiopian women after fistula repair surgery to identify priority post-repair interventions that could maximise their quality of life. The results showed that the majority of women felt a dramatic sensation of relief and happiness following repair, yet some continued to experience mental anguish, stigma, and physical problems regardless of the outcome of the procedure. All women suffered intense fear of developing another fistula, most commonly from sex or childbirth. Despite this, the majority of women had sex or planned to do so, while a smaller cohort avoided intercourse and childbearing, thus subjecting them to isolation, marital conflict, and/or economic vulnerability. Our findings suggest that obstetric fistula programmes should integrate (1) post-repair counselling about fistula and risk factors for recurrence, (2) community-based follow-up care, (3) linkages to income-generating opportunities, (4) engagement of women affected by fistula for community outreach, and (5) metrics for evaluating rehabilitation and social reintegration efforts to ensure women regain healthy, productive lives.

An integrative review on women living with obstetric fistula and after treatment experiences

“…, Khisa & Nyamongo , Donnelly et al . ). Three studies reported, women lacked the desire or interest in sex due to their fistula experience (Turan et al .…”

“…, Donnelly et al . ). Consequently, these women became economically dependent on family income for sustenance, and their quality of life and reintegration became compromised (Mselle et al .…”

“…() and Donnelly et al . () reported some husbands supported their wives in dealing with their fistula problems. But those left unsupported and rejected tended to return to their birth homes (EngenderHealth , Landry et al .…”

Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study

“…Our identification of non‐incontinence‐related persistent symptoms is also not unique; in a qualitative study of women repaired for fistula in Ethiopia, Donnelley et al . reported that 40% of women reported physical health problems following surgery irrespective of their repair status. The substantial and significant differences in level of reintegration comparing women with persistent physical symptoms and those without support additional intervention to resolve physical symptoms in order to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.…”

‘As a man I felt small’: a qualitative study of Ugandan men’s experiences of living with a wife suffering from obstetric fistula

“…In Uganda, 2% of women aged 15-49 years have had fistula, mainly due to obstructed labour (UBOS, and ICF International Inc 2012). Fistula is known to affect the lives of both the woman and her social networks including relatives, especially the husband (Donnelly et al 2015;Women's Dignity Project, Engender Health's 2006). Women with fistula experience multiple losses and are often abandoned by their husbands, who then remarry women who can fulfil marital roles (Mselle et al 2011).…”