title: Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming.
abstract: Despite growing recognition of the importance of linking obstetric fistula prevention and treatment strategies with rehabilitation and social reintegration programmes, little research and programming has been oriented toward this goal. Using in-depth interviews, this study aimed to examine the experiences of 51 Ethiopian women after fistula repair surgery to identify priority post-repair interventions that could maximise their quality of life. The results showed that the majority of women felt a dramatic sensation of relief and happiness following repair, yet some continued to experience mental anguish, stigma, and physical problems regardless of the outcome of the procedure. All women suffered intense fear of developing another fistula, most commonly from sex or childbirth. Despite this, the majority of women had sex or planned to do so, while a smaller cohort avoided intercourse and childbearing, thus subjecting them to isolation, marital conflict, and/or economic vulnerability. Our findings suggest that obstetric fistula programmes should integrate (1) post-repair counselling about fistula and risk factors for recurrence, (2) community-based follow-up care, (3) linkages to income-generating opportunities, (4) engagement of women affected by fistula for community outreach, and (5) metrics for evaluating rehabilitation and social reintegration efforts to ensure women regain healthy, productive lives.
authors.affiliation: a The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College , Lebanon , NH , USA.
authors.forename: Kyla
authors.initials: K
authors.lastname: Donnelly
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Oliveras
authors.forename: Yewondwossen
authors.initials: Y
authors.lastname: Tilahun
authors.forename: Mehari
authors.initials: M
authors.lastname: Belachew
authors.forename: Mengistu
authors.initials: M
authors.lastname: Asnake
mesh_terms: D000293:Adolescent; D000328:Adult; D005002:Ethiopia; D005260:Female; D006801:Humans; D012929:Psychological Distance; D011640:Public Policy; D011788:Quality of Life; D012725:Sexual Behavior; D012934:Social Isolation; D058992:Social Participation; D057545:Social Stigma; D016896:Treatment Outcome; D014624:Vaginal Fistula / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery; D055815:Young Adult
keywords: Ethiopia; obstetric fistula; rehabilitation; reproductive health; social reintegration