Reintegration to Family and Community after Obstetric Fistula Surgery: Experiences of Ugandan Women

Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women, most in sub-Saharan Africa. While the past decade has witnessed increasing efforts to scale up surgical fistula repair services, little is known regarding the success of the woman’s post-surgical reintegration into her family and community. The aim of this qualitative study was to explore the post-surgical reintegration process, and to better understand factors that support or inhibit recovery.

Collaborators from the Makerere University School of Medicine and the University of California, San Francisco conducted 16 key informant interviews and 4 focus group discussions over the period June – July 2014 with women who had obstetric fistula surgery at Mulago Hospital in the previous 6 – 24 months. Questions focused on the effect of obstetric fistula on women’s daily lives, including their mental and physical health, and post-surgical emotional, physical, social and financial experiences.  Data was analyzed using deductive and inductive coding, using Atlas.ti.

Women reported a variety of physical and emotional stresses due to developing obstetric fistula including pain and weakness, depression, social isolation, and internal and external stigma. Symptoms and hygiene needs drastically reduced women’s activities, capabilities and autonomy. Many participants reported receiving emotional and tangible support from husbands and family members, and encouragement from women with fistula at the surgical camp.  Perceptions of recovery focused on continence. Residual symptoms prohibited resumption of previous activities after surgery for some women. Respondents indicated the need for instrumental support for surgery and attaining economic productivity after surgery.  

Achievement of continence is key for women with fistula. Counseling, health education, physical and occupational therapy, and economic assistance will likely contribute to substantial improvements in quality of life. As fistula-repair services expand, it is essential to develop and provide programming to enhance women’s post-repair family and community reintegration.