Impact of beyond Fistula programming on economic, psychosocial and empowerment outcomes following female genital fistula repair: A retrospective study

Abstract

Background The severe physical, psychosocial, and economic consequences of fistula suggest that post-surgical reintegration programming that incorporates a holistic approach may optimize recovery. However, there is a gap in knowledge around best practices for women’s post-surgical reintegration programming and limited assessment of reintegration programming among women who have undergone genital fistula repair. Thus, the objective of this study was to retrospectively assess changes in economic status, psychosocial status and empowerment among women who participated in Beyond Fistula reintegration programming following surgical fistula repair Methods We conducted a retrospective survey among 100 Beyond Fistula (El Doret, Kenya) participants capturing sociodemographic characteristics, obstetric and fistula history, program participation, economic status (income and employment), psychosocial status (reintegration, self-esteem, depressive symptoms), and empowerment (engagement in household decision-making and intimate partner violence). Economic status, psychosocial status and empowerment were captured for two time points: prior to program participation and currently and compared using paired t-tests or McNemar’s tests.Results specifically when comparing economic status prior to program participation to afterwards, we noted statistically significant increases in the proportion of individuals owning property (28.0% vs. 38.0%, p=0.0063), having current source of income (19.0% vs. 56.0%, p<0.001), and saving or investing income (11.0% vs. 37.0%, p<0.001). We also identified statistically significant increases from pre to post programming in self-esteem (5.0 (IQR 4.0-5.0) vs. 5.0 (IQR 5.0-5.0), p=0.0001), reintegration (53.0 (IQR 43.0-69.0) vs. 65.0 (IQR 51.0-72.0), p<0.001) and level of input into household economic decision-making (2.0 (SD 1.0) vs. 2.3 (SD 1.0), p=0.004).Conclusions Our findings suggest that participation in Beyond Fistula programming improved economic status, psychosocial status, and empowerment of participants. Post-surgical interventions incorporating a holistic approach can advance recovery through supporting psychosocial and economic wellbeing and should be offered to women undergoing genital fistula repair.