title: Exploring the needs and challenges of women reintegrating after obstetric fistula repair in northern Ghana.
abstract: OBJECTIVE
  to explore the cultural, social and economic needs and challenges of women in northern Ghana as they resume their day-to-day lives post obstetric fistula repair.
  
  
  METHODS
  a critical ethnographic approach.
  
  
  METHODS
  a state run fistula treatment center in Tamale, northern Ghana, and 24 rural communities in northern Ghana.
  
  
  METHODS
  ninety-nine (N=99) participants were recruited using purposive, convenience and snowball sampling. The sample consisted of women (N=41) who had experienced an obstetric fistula repair and their family members (N=24). Health care providers (N=17) and stakeholders (N=17) who had specialised knowledge about reintegration programs at a community or national level were also included.
  
  
  RESULTS
  the needs and challenges of northern Ghanaian women post obstetric fistula repair were historically and culturally rooted. A woman's psychosocial acceptance back into her community post obstetric fistula was significant to her well-being but many women felt they had to 'prove' themselves worthy of acceptance and hid any signs of urinary incontinence post obstetric fistula repair. The cost of treatment compounded by a woman's inability to work while having the obstetric fistula exaggerated her economic needs. Skills training programs offered assistance but were often not suited to a woman's physical capability or geographic location. Many women who have experienced obstetric fistula along with women leaders have initiated obstetric fistula awareness campaigns in their communities with the aim of overcoming the challenges and improving the reintegration experiences of others who have had an obstetric fistula repair.
  
  
  CONCLUSIONS
  developing understanding about the needs and challenges of women post obstetric fistula is an important step forward in creating social and political change in obstetric fistula care and reintegration.
  
  
  CONCLUSIONS
  Strategies to support women reintegrating to their communities post obstetric fistula repair include exploring alternative forms of skills training and income generation activities, creating innovative pre and post obstetric fistula health education and community awareness to reduce the perception of the condition as 'incurable', and promoting peer advocacy.
authors.affiliation: University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9 Canada. Electronic address: kdjarvis@ualberta.ca.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Jarvis
authors.affiliation: University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9 Canada. Electronic address: mrichter@ualberta.ca.
authors.forename: Solina
authors.initials: S
authors.lastname: Richter
authors.affiliation: University of Alberta, 13-22 HM Tory Building, Edmonton, Alberta, T6G 2H4 Canada. Electronic address: hv@ualberta.ca.
authors.forename: Helen
authors.initials: H
authors.lastname: Vallianatos
mesh_terms: D000293:Adolescent; D000328:Adult; D000884:Anthropology, Cultural / Q000379:methods; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000523:psychology; D011247:Pregnancy; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012006:Rectovaginal Fistula / Q000150:complications / Q000209:etiology / Q000523:psychology*; D012424:Rural Population; D057545:Social Stigma; D014719:Vesicovaginal Fistula / Q000150:complications / Q000209:etiology / Q000523:psychology*
keywords: Critical ethnography; Gender; Ghana; Maternal health; Obstetrical fistula; Reintegration