title: The psychosocial impact of vesico-vaginal fistula in Niger.
abstract: OBJECTIVE
  To explore the psycho-social impact of vesico-vaginal fistula (VVF) on women in Niger.
  
  
  METHODS
  We conducted a qualitative study on 21 women in convalescence at the DIMOL Reproductive Health Center in Niamey, Niger, in 2008 and 2009. The women had undergone 1-3 fistula repair operations and all had stillborn infants.
  
  
  RESULTS
  Women reported many psychological consequences of VVF including depression, feelings of shame, and loneliness. Others reported feeling devalued as a woman and wanting to end their lives. Social consequences of fistula reported by these women included rejection from society, isolation, rejection from husband and/or divorce. Almost half of the women reported of having lost their social network and support as a result of the fistula. Women with VVF were deemed unworthy, and their illness was often attributed to some fault of their own.
  
  
  CONCLUSIONS
  Our findings support the notion that socio-economic factors, though they certainly contribute to obstetric fistula, are not the primary reason for fistula, particularly in Niger. Fistula is a direct result of lack of access to skilled birth attendants and emergency obstetric care.
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL 33612, USA. aalio@health.usf.edu
authors.forename: Amina P
authors.initials: AP
authors.lastname: Alio
authors.forename: Laura
authors.initials: L
authors.lastname: Merrell
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Roxburgh
authors.forename: Heather B
authors.initials: HB
authors.lastname: Clayton
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Marty
authors.forename: Linda
authors.initials: L
authors.lastname: Bomboka
authors.forename: Salamatou
authors.initials: S
authors.lastname: Traoré
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression; D004243:Divorce; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008132:Loneliness / Q000523:psychology; D008875:Middle Aged; D009548:Niger; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011248:Pregnancy Complications; D012059:Rejection, Psychology; D012752:Shame; D057545:Social Stigma; D014719:Vesicovaginal Fistula / Q000150:complications* / Q000209:etiology / Q000523:psychology*; D055815:Young Adult