Experiences with fistula repair surgery among women and families in Malawi

Abstract

Fistula treatment through surgery is reported to be successful in 80–90% of cases. Success in fistula repair has been defined by medical professionals in terms of clinical outcomes; beyond these definitions, it is important to understand how women perceive a positive clinical outcome and how it affects her family and home environment. This research was conducted in the Mangochi District of Malawi to answer these questions through interviews with women living with fistula and after surgical repair, as well as their partners and families. Over 104 interviews were conducted in June and October 2007. While eventually experiencing clinically successful surgical outcomes, women reported difficulty in seeking and receiving healthcare. Bureaucratic challenges were complicated by community misperceptions about the condition and fear of the healthcare system. Perspectives of women's families suggest that burdens and social disabilities caused by fistula extended beyond the individual to affect these family members. When women experienced surgical treatment, positive outcomes spread to her family and community. Positive experiences with the healthcare system turned women into advocates for healthcare in their communities. These findings illustrate that issues of obstetric fistula are not limited to individual women, but can dramatically affect their families, partners and communities.

Keywords:

• obstetric fistula
• Malawi
• quality of life
• maternal morbidity
• qualitative data analysis

Acknowledgements

The authors appreciate the assistance of Agnes Chimbiri and Mary Sibande, and thank the community officials, women and men who participated in this study. Comments from anonymous reviewers are also appreciated. This research received support from the Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health.

Notes

1. Participants were defined as having fistula based on a verbal symptomatic assessment designed to distinguish fistula cases from other types of incontinence. However, presence of fistula was not confirmed by physical exam. It is possible that some participants in the study experienced urinary incontinence for reasons other than obstetric fistula.