Abstract:

Obstetric fistula affects women’s social lives, and some women still experience stigma and marital challenges even after successful repair. There is limited information on the experiences of reintegration after a successful fistula repair and a gap remains in the experiences of reintegration services, affecting implementation and policy implications for fistula repair programs. The data for the study was an in-depth interview guide and interviews were audio-taped with permission from participants, transcribed verbatim, and analyzed using thematic analysis. Four (4) main themes, two (2) emerged themes, and thirteen (13) subthemes were generated from the data. All four major themes were derived from the constructs of the socio-ecological model which was used to develop the objectives which guided the study. The findings show that although there is support for treatment, there are no formal support structures for the reintegration of obstetric fistula survivors.

References:

[1]. Tyer‐Viola, L. A., & Lopez, R. P., 2014. Pregnancy with chronic illness. Journal of Obstetric, Gynecologic & Neonatal Nursing, 43(1), 25-37. 

[2]. Guardino, C. M., Schetter, C. D., Hobel, C. J., Lanzi, R. G., Schafer, P., Thorp, J. M., & Shalowitz, M. U., 2017. Chronic stress and C-reactive protein in mothers during the first postpartum year. Psychosomatic medicine, 79(4), 450.

[3]. Swain, D., Parida, S. P., Jena, S. K., Das, M., & Das, H., 2020. Prevalence and risk factors of obstetric fistula: implementation of a need-based preventive action plan in a South-eastern rural community of India. BMC women's health, 20, 1-10.

[4]. Ryan, F., 2014. The ‘Typical Story’of Obstetric Fistula: The Need to Enhance Awareness, Action and Funds.

[5]. World Health Organization. 2018. Obstetric fistula. https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula

[6]. Lombard, L., de St. Jorre, J., Geddes, R., El Ayadi, A. M., & Grant, L., 2015. Rehabilitation experiences after obstetric fistula repair: systematic review of qualitative studies. Tropical Medicine & International Health, 20(5), 554-568.

[7]. Drew, Wilkinson, J. P., Nundwe, W., Moyo, M., Mataya, R., Mwale, M., & Tang, J. H., 2016. Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC pregnancy and childbirth, 16, 1-12.

[8]. UNFPA. 2015. Neglected no more: Ending fistula. http://www.unfpa.org/resour ces/neglected-nomore-fact-sheet United.

[9]. Bomboka, J. B., N-Mboowa, M. G., & Nakilembe, J., 2019. Post-effects of obstetric fistula in Uganda; a case study of fistula survivors in KITOVU mission hospital (MASAKA), Uganda. BMC public health, 19, 1-7.

[10]. Jarvis, K., Richter, S., & Vallianatos, H., 2017. Exploring the needs and challenges of women reintegrating after obstetric fistula repair in northern Ghana. Midwifery, 50, 55-61.

[11]. Mantey, R., Kotoh, A. M., Barry, M., & Redington, W., 2020. Womens’ experiences of living with obstetric fistula in Ghana–time for the establishment of a fistula centre of excellence. Midwifery, 82, 102594.

[12]. Meurice, M. E., Ahmed, S., & Génadry, R. 2022. Obstetric Fistula: A Case of Miscommunication—Social Experiences of Women with Obstetric Fistula. A Multidisciplinary Approach to Obstetric Fistula in Africa: Public Health, Anthropological, and Medical Perspectives, 107-119.

[13]. Mwini-Nyaledzigbor, P. P., Agana, A. A., & Pilkington, F. B., 2013. Lived experiences of Ghanaian women with obstetric fistula. Health care for women international, 34(6), 440-460.

[14]. Pilkington, F. B., Mwini-Nyaledzigbor, P., & Agana, A. A., 2022. The Experience of Childbirth and Obstetric Fistula: Perspectives of Women in Northern Ghana. In A Multidisciplinary Approach to Obstetric Fistula in Africa: Public Health, Anthropological, and Medical Perspectives (pp. 121-134). Springer.

[15]. Jarvis, K., Richter, S., Vallianatos, H., & Thornton, L., 2017. Reintegration of women post obstetric fistula repair: experience of family caregivers. Global qualitative nursing research, 4, 2333393617714927.

[16]. Sufuyani, G. 2019. Lived experiences of women with obstetric fistula in the Wa Municipality University of Cape Coast].

[17]. UNFPA. 2022. Towards Ending Obstetric Fistula by 2030: A Call for Transformative Action and Strategic Partnerships to Address the Protracted Crisis in West and Central Africa. https://wcaro.unfpa.org/en/news/towards-ending-obstetric-fistula-2030-call-transformative-ac

[18]. Bashah, D. T., Worku, A. G., & Mengistu, M. Y., 2018. Consequences of obstetric fistula in sub Sahara African countries, from patients’ perspective: a systematic review of qualitative studies. BMC women's health, 18(1), 106. https://doi.org/10.1186/s12905-018-0605-1

[19]. Kalembo, F., & Zgambo, M., 2012. Obstetric fistula: a hidden public health problem in Sub-Saharan Africa. Arts and Social Sciences Journal.

[20]. Feldacker, C., Ennett, S. T., & Speizer, I., 2011. It’s not just who you are but where you live: an exploration of community influences on individual HIV status in rural Malawi. Social science & medicine, 72(5), 717-725.

[21]. Ghana Health Service. 2015. Report on the Assessment of Obstetric Fistula in Ghana. G. H. Service. https://www.sciencedirect.com/science/article/pii/S0266613819302852#bbib0012

[22]. Ghana Statistical Service

[23]. Saunders, C. H., Sierpe, A., von Plessen, C., Kennedy, A. M., Leviton, L. C., Bernstein, S. L., Goldwag, J., King, J. R., Marx, C. M., & Pogue, J. A., 2023. Practical thematic analysis: a guide for multidisciplinary health services research teams engaging in qualitative analysis. bmj, 381.  

[24]. Nduka, I. R., Ali, N., Kabasinguzi, I., & Abdy, D., 2023. The psycho-social impact of obstetric fistula and available support for women residing in Nigeria: a systematic review. BMC Women's Health, 23(1), 87.

[25]. Siddle, K., Mwambingu, S., Malinga, T., & Fiander, A., 2013. Psychosocial impact of obstetric fistula in women presenting for surgical care in Tanzania. International urogynecology journal, 24, 1215-1220.

[26]. Donnelly, K., Oliveras, E., Tilahun, Y., Belachew, M., & Asnake, M., 2015. Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming. Culture, health & sexuality, 17(2), 150-164.

[27]. Gebresilase, Y. T., 2014. A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia. International journal of women's health, 1033-1043.

[28]. Sunday-Adeoye, I., Daniyan, A., Eliboh, M., Mighty-Chukwu, I., Ekwedigwe, K., Nweke, U., Chigbo, E., & Anah, C., 2017. Re-integration of women who had repair of obstetric fistula–a pilot study. Ijsrm. Human, 8, 15-28.

[29]. Barageine, J. K., 2015. Genital Fistula Among Ugandan Women: Risk Factors, Treatment Outcomes, and Experiences of Patients and Spouses. Karolinska Institutet (Sweden).

[30]. Mohamed, A. A., Ilesanmi, A. O., & Dairo, M. D., 2018. The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia. Obstetrics and Gynecology International, 2018, 5250843. https://doi.org/10.1155/2018/5250843

[31]. Delamou, A., Douno, M., Bouédouno, P., Millimono, S., Barry, T. H., Tripathi, V., & Diallo, M., 2021. Social immersion for women after repair for obstetric fistula: an experience in Guinea. Frontiers in Global Women's Health, 2, 713350.

[32]. Dennis, A. C., Wilson, S. M., Mosha, M. V., Masenga, G. G., Sikkema, K. J., Terroso, K. E., & Watt, M. H., 2016. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania. International journal of women's health, 429-439.

[33]. Khisa, A. M., 2015. An exploratory study of reintegration of women following obstetric fistula surgery in West Pokot, Kenya. SAGE Open, 5(4), 2158244015621112. 

[34]. De Sousa Machado, T., Chur-Hansen, A., & Due, C., 2020. First-time mothers’ perceptions of social support: Recommendations for best practice. Health psychology open, 7(1), 2055102919898611.

[35]. Odonkor, S. T., & Yeboah, T. N., 2023. Challenges of rural women living with obstetric fistula: A phenomenological study. Women and Birth, 36(1), e1-e9. https://doi.org/https://doi.org/10.1016/j.wombi.2022.04.001

[36]. Marino, R., & Lietaert, I., 2022. 12. The legitimisation of the policy objective of sustainable reintegration. Handbook of return migration, 167.

[37]. Baker, Z., Bellows, B., Bach, R., & Warren, C., 2017. Barriers to obstetric fistula treatment in low‐income countries: a systematic review. Tropical Medicine & International Health, 22(8), 938-959.

[38]. Drew, L. B., Wilkinson, J. P., Nundwe, W., Moyo, M., Mataya, R., Mwale, M., & Tang, J. H., 2016. Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC Pregnancy and Childbirth, 16(1), 2. https://doi.org/10.1186/s12884-015-0755-1

[39]. Khisa, A. M., & Nyamongo, I. K., 2012. Still living with fistula: an exploratory study of the experience of women with obstetric fistula following corrective surgery in West Pokot, Kenya. Reproductive Health Matters, 20(40), 59-66. https://doi.org/https://doi.org/10.1016/S0968-8080(12)40661-9

[40]. Tilahun, Y., Kyla, D., Elizabeth, O., Mehari, B., & Mengistu, A., 2013. A qualitative analysis of the experience of women supported by the integrated family health project to reach fistula repair services: their experience of repair services and re-integration. 2013. In.