Experiences, psychosocial challenges and social integration of women with obstetric fistula in selected hospitals In central and Western Uganda

Abstract

Obstetric fistula is a worldwide public health challenge affecting more than two million women and girls worldwide. According to Uganda Health Demographic Survey report of 2011 it was reported that 2.6% of women of reproductive age in Uganda have experienced fistula. Women with fistula live with physical and psycho social challenges because most do not get appropriate health and social care. The study objectives were to; establish experiences faced by women during pregnancy, delivery, and post delivery for the pregnancy that caused fistula, identify psycho social challenges experienced by women wih fistula, establish coping mechanisms and identify factors that enhance integration of women affected by fistula in the community. A cross sectional descriptive design was used for the study. Quantitative data was gathered using a questionnaire while Focus Group discussions, Indepth and Key Informant Interviews were used to collect the qualitative data. Two hundred four women were purposively selected and interviewed from Mulago national referral hospital located in central Uganda and two district private hospitals, that is, Kagando in western Uganda, and Kitovu in central Uganda. The key findings of the study were; the majority of women with fistula were in age range of 15-20 years (28.4%), and most had low levels of education whereby 22.5% never attended school, and (55.8%), attained primary levels of education. Majority got fistula on first order of delivery 116 (56.8%), 111 (54.4%) delivered by caesarean section for the delivery that caused fistula after prolonged labour. A significant number had separted from husband because of fistula (29.5%). The psycho social challenges included; isolation, feelings of sadness, shame, worthlessness, self dislike, reduced self esteem, concentration difficulties and experiences of suicidal thoughts. Fistula victims coped through keeping proper hygiene, use of pampers and pieces of cloths as pads to reduce leakage of urine and feaces, isolation from the public, prayer, family support and care and some practicing sexual abstinence. Integration of women with fistula requires community sensitization and education, counselling for fistula survivors and family, financial support to enable them engage in income generating work. The study recommended facilitation of hospitals to offer appropriate fistula repair services, capacity building for health personnel to provide the required services, community education on prevention and care for fistula. The study concludes that women who give birth at young age, with low levels of education and from poor families have a high risk of getting fistula and sufer for a long time.