An integrative review on women living with obstetric fistula and after treatment experiences.
OBJECTIVE
To review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research.


BACKGROUND
Obstetric fistula is an injury most commonly resulting from a prolonged labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women's experience is required to inform holistic approaches for care and prevention.


METHODS
A search of literature was conducted on databases of EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; and websites of international organizations such as Women's Dignity Project and EngenderHealth. Keywords, Inclusion and exclusion criteria were defined and 25 articles published between 2004 to January 2015 were identified.


METHODS
An integrative review of 25 articles was carried out.


RESULTS
Three broad themes were identified: Challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fistula repair.


CONCLUSIONS
Living with a fistula presents multidimensional consequences affecting women, families and communities. Accessing treatment is difficult and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being continent thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Post repair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore further research is required to support its benefits; and for policy development to meet care provision for women with fistula.


CONCLUSIONS
The review provides insights into avenues of improving care provision and delivery by health professionals and policy makers. It also exposes areas that need further research for quality care provision.
Faculty of Health and Social Care, University of Hull, Hull, UK.
Hannah
H
Mafo Degge
Sexual and Reproductive Health, Faculty of Health and Social Care, University of Hull, Hull, UK.
Mark
M
Hayter
Faculty of Health and Social Care, University of Hull, Hull, UK.
Mary
M
Laurenson
D017954:Africa South of the Sahara; D001208:Asia; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011788:Quality of Life; D012944:Social Support; D013240:Stereotyping; D014624:Vaginal Fistula / Q000523:psychology* / Q000628:therapy
holistic care; integrative review; obstetric fistula; postrepair care; quality of life; rehabilitation; reintegration