Still living with fistula: an exploratory study of the experience of women with obstetric fistula following corrective surgery in West Pokot, Kenya

Abstract

Obstetric fistula is a complication of pregnancy that affects women following prolonged obstructed labour. Although there have been achievements in the surgical treatment of obstetric fistula, the long-term emotional, psychological, social and economic experiences of women after surgical repair have received less attention. This paper documents the challenges faced by women following corrective surgery and discusses their needs within the broader context of women's health. We interviewed a small sample of women in West Pokot, Kenya, during a two-month period in 2010, including eight in-depth interviews with fistula survivors and two focus group discussions, one each with fistula survivors and community members. The women reported continuing problems following corrective surgery, including separation and divorce, infertility, stigma, isolation, shame, reduced sense of worth, psychological trauma, misperceptions of others, and unemployment. Programmes focusing on the needs of the women should address their social, economic and psychological needs, and include their husbands, families and the community at large as key actors. Nonetheless, a weak health system, poor infrastructure, lack of focus, few resources and weak political emphasis on women's reproductive health do not currently offer enough support for an already disempowered group.

Health‐related quality of life among women in rural Bangladesh after surgical repair of obstetric fistula

“…Sexual functioning-an important aspect of health-related QOL after surgical repair [14]-was not included in the SF-36 questionnaire [25]. Additionally, the current findings cannot be generalized to women outside northwestern Bangladesh; the sample size was insufficient to extend the association.…”

“…The role failure as a wife and mother, apart from the stigmatized illness itself, might perpetuate discrimination within the Bangladeshi context. Another possible reason for the perpetuation of discrimination could be that once a label is attached to a woman with an illness, that label marks her as "socially polluted" [14]; consequently, the label might be difficult to remove.…”

“…For example, one study stated that "long after corrective surgery, the women were still living with memories of fistula and made every effort to block out any linkage to fistula" [14]. Stillbirth was also found to markedly reduce women's physical health [24].…”

“…gynatresia, amenorrhea, and leg weakness) have also been reported [13]. Furthermore, some women still experienced social and economic difficulties, stigma, or emotional pain [10,14].…”

Female Genital Mutilation in Kenya: are young men allies in social change programmes?

“…16,17 Research setting West Pokot is a semi-arid area in Western Kenya populated mainly by the Pokot people, who are a Nilotic tribe dependent on nomadic pastoralism. 18 Unemployment is high in West Pokot, with only 5% counted as wage earners. Educational enrolment is low, with only 27% of children enrolled in secondary education.…”