Long-term outcomes for women after obstetric fistula repair: A qualitative study

Abstract

Background: Women with obstetric fistula suffer many physical, social, and economic consequences. Surgery can successfully treat the physical damage of an obstetric fistula; however, challenges that affect women's quality of life may persist when they reintegrate into their communities. This qualitative study assessed the long-term outcomes and quality of life among women who received surgical repair for obstetric fistula in Malawi. Structure/Method/Design: In-depth interviews were conducted with 20 women from-seven districts across Central Malawi. All women were 1 to 2 years status postsurgical repair for obstetric fistula at the Fistula Care Centre in Lilongwe, Malawi. We explored three domains: quality of life before and after fistula repair, reproductive intentions and marriage, and understanding of fistula. Interviews were independently coded and analyzed using content analysis. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): At the time of the interview, 9 of 20 women (45%) reported some degree of urinary incontinence. All but one woman reported the quality of their lives had improved since surgery. Sub-themes included feeling a sense of freedom and peace after repair, improved confidence and relationships with relatives and friends, and increased community involvement and income-generating ability. Over half reported they were welcomed back into their communities and had no challenges with reintegration. Almost all women had experienced stigma before surgery, but only one continued to face stigma after surgery. Prior to surgery, women's greatest concerns were that their fistula could not be repaired, that they would die during surgery, and marital discord. After surgery, their greatest concerns were financial challenges, the need for additional surgery, husbands with other wives, and desire for a husband and future children. Most women understood that fistula was caused by delays seeking a health center during labor and were now counseling other women to go to the hospital early.However,myths about witchcraft and fear of delivery causing fistula were present in their communities. Summary/Conclusion: Nearly all women who underwent fistula repair felt that their quality of life had improved at the individual, interpersonal, and community levels, even among women who continued to have urinary incontinence. Contrary to other studies, the majority of women did not have challenges reintegrating into their communities. However, many continued to have problems with their husbands and were concerned about their future fertility, issues which need to be further explored in other studies.