title: Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania.
abstract: OBJECTIVE
  An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration.
  
  
  METHODS
  The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20).
  
  
  RESULTS
  Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs.
  
  
  CONCLUSIONS
  Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients.
authors.affiliation: Duke Global Health Institute, Duke University.
authors.forename: Alexis C
authors.initials: AC
authors.lastname: Dennis
authors.affiliation: Duke Global Health Institute, Duke University; Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Wilson
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania.
authors.forename: Mary V
authors.initials: MV
authors.lastname: Mosha
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania.
authors.forename: Gileard G
authors.initials: GG
authors.lastname: Masenga
authors.affiliation: Duke Global Health Institute, Duke University; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.affiliation: Duke Global Health Institute, Duke University.
authors.forename: Korrine E
authors.initials: KE
authors.lastname: Terroso
authors.affiliation: Duke Global Health Institute, Duke University.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
keywords: Tanzania; maternal morbidity; obstetric fistula; social support