Counseling Obstetric Fistula Patients in Eritrea

Obstetric fistula is a devastating problem impacting the health and psychosocial well-being of affected women and their families. In Eritrea, efforts are being made to meet the complex needs of women who develop fistulas. Based on in-depth interviews conducted with fistula repair clients, a counseling program for such clients was adapted for the Eritrean context. the aims of the program were: (1) to provide information about fistula, fistula prevention, and surgical repair, (2) to improve women's self esteem, (3) to help women to explore ways to re-integrate into their communities following surgical repair, and (4) to encourage dicussion of fistula and fistula prevention with community members. Forty-seven women were counseled before and after their surgical repairs. To evaluate the intervention, clients were interviewed twice: once before pre-operative counseling and again after post-operative counseling. A questionnaire was used to assess women's knowledge about fistula, self-esteem, and behavioral intentions for post-surgery health maintenance and social re-integration. After counseling, program participants showed statistically significant improvements in their knowledge about fistula, self-esteem, and intentions to educate others about fistula. In addition, there was a statistically significant improvement in women's desire to engage in behaviors beneficial to their health, such as the use of family planning. This project represents the first formal implementation and evaluation of a counseling program for fistula patients in sub-Sharan Africa, and will likely serve as a model for other countries. In addition, such efforts to prevent and treat fistula can serve as a focal point to generate support for safe motherhood policies and programs.