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Impact of surgery on quality of life of women with obstetrical fistula: a qualitative study in Burkina Faso

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Abstract

Introduction and hypothesis

Obstetric fistula, caused by traumatic delivery and patient lack of access to obstetric care, is an important public health concern in developing countries, particularly in Sub-Saharan Africa. This research focuses on the experience of women living with obstetric fistula in Burkina Faso as well as their reintegration into community after surgery.

Methods

This project was funded by the Mères du Monde en Santé (MMS) Foundation and conducted in collaboration with the Boromo Hospital. A qualitative approach based on grounded theory and using the principles of participative action research (PAR) was used with semidirected interviews prior to surgery and follow-up interviews 1–2 years after surgery directly in the women’s village of origin. Thirty-nine participants were recruited between 2012 and 2015.

Results

The results point to circumstances leading to obstetric fistula development: poverty, gender inequality in terms of decision making, healthcare-system deficiencies, and lack of services for referral and treatment of this condition. Our results reinforce the knowledge about the social and psychological repercussions of fistula by exploring the concepts of gossips, shame and self-exclusion as powerful mechanisms of exclusion, but they also show that social support was conserved for several women through their journey with this disease. There was complete social rehabilitation within the community after surgery; however, persistent barriers in term of anxiety regarding obstetric future and economic insecurity were present.

Conclusions

Early recruitment for surgery and prevention are the main objectives when attempting to reduce the impact of obstetric fistula and facilitate patient reintegration. Improvements in local and governmental public health policies are required.

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Acknowledgements

We thank research assistants and interpreters Laurence Bernard, Stéphanie Breton, Alessandro Carini, Maria Cherba, Catherine Coulombe, Marie-Charlotte De Koninck, Célia Ido and Safiatou Ouédraogo.

Author information

Authors and Affiliations

  1. Department of Obstetrics, La Salle Hospital, McGill University, LaSalle, Québec, Canada

    Julie Désalliers

  2. Clinique Espace Santé, 8 Place du Commerce, Verdun, QC, Canada, H3E1N3

    Julie Désalliers

  3. Department of Anthropology, Université de Montréal, Montréal, Québec, Canada

    Marie-Eve Paré

  4. Department of Sociology, Université de Ouagadougou, Ouagadougou, Burkina Faso

    Salam Kouraogo

  5. Department of Urology, Jewish General Hospital, McGill University, Montréal, Québec, Canada

    Jacques Corcos

Authors
  1. Julie Désalliers
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  2. Marie-Eve Paré
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  3. Salam Kouraogo
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  4. Jacques Corcos
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Corresponding author

Correspondence to Julie Désalliers.

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Conflicts of interest

None.

Financial disclaimers

This study was supported and funded by the Mères du Monde en Santé Foundation to provide long-term medical support and social follow-up of women who have undergone surgery, with the objective of identifying obstacles to rehabilitation to improve future interventions.

Funding

This study was supported and funded by the MMS Foundation to provide long-term medical support and social follow-up of women who have undergone surgery, with the objective of identifying obstacles to rehabilitation to improve future interventions.

Appendices

Appendix 1. Sociodemographic questionnaire

figure a

Appendix 2. Interview guides in phases 1 and 2

Phase 1

- Could you describe the delivery that led to the fistula? How long did you remain at home before being brought to the clinic? How much time elapsed before you were transferred from the clinic to the hospital? Did you have to pay for transportation? Who accompanied you to assist you? Who made the decision to take you to the CSPS/to keep you at home? How were you treated by the healthcare staff at the clinic/the hospital? How did your in-laws treat you? Your husband?

- Did you lose the baby that time? How did you feel afterward? Did you receive support from your husband/in-laws/family? From healthcare personnel?

- How did you learn/come to realize that you had fistula? How did you react when you found out? What did you do? Did you consult? What did they tell you? What happened to you afterward? Did you have easy access to information about fistula/treatment?

- How has fistula affected your daily life? Work? Household chores? Economic situation?

- How has this condition affected your relationship with your husband? How did he react?

- Do you find that your relationship with your husband has changed? And with your co-wives?

- Did you get support from members of your immediate family? What was their reaction? How are they taking it?

- Did your friends know about it? How did they react? Did you have their support? Why did you hide it from them?

- Was your village/community aware of it? How did they treat you?

- Can you still participate in social events? Do you attend celebrations? Go to the market? To the mosque? Can you use transportation?

- On a personal level, how are you feeling since this happened? (Depressed? Humiliated? Isolated? Loss of self-esteem? Frustrated? Suicidal?)

- How did you learn you could have access to surgery on this fistula? Do you have any fears about the surgery? What are your hopes from the surgery? What is the first thing you would do if you were cured of fistula?

- How do you envisage future pregnancy?

- What have you heard about fistula? Do the women around you talk about it, or it is a subject you have never heard of before? What do they say? How do you feel about having met all these other women here who suffer from the same condition as you?

- Do you believe women lack information about the risk of developing fistula?

- How did you find the care you received from the clinic/hospitals during your delivery/follow-up for fistula?

Phase 2

- How did the operation go? Did you remain in hospital for a long time after the operation?

- Did you recover rapidly after the operation?

- Do you think the operation has been beneficial? Are you still suffering from incontinence? If so, describe the problem.

- Have you started to work again? Resumed daily activities? If so, how long after the surgery? What tasks are you doing? (Farm work? Fetching water? Housework?)

- Have you had sexual relations with your husband since the surgery? Do you have any problems in this respect, or is it going well? (Any pain, etc.)?

- Have you since become pregnant and with what result?

- Have you resumed the economic activities you were doing previously before you got fistula? Have you regained your financial independence? What is your financial situation? Have you reimbursed the expenses you incurred because of the fistula?

- Have you received any help with your reintegration (from an organization, micro-credit, etc.)?

- How are things going with your husband since the surgery? Did he reject you when you had fistula, or did you still have his support? Have you returned to living with him? How does he treat you? For repudiated women: Have you found a new spouse? Do you want to remarry?

- Do you think you will become pregnant again?

- How are things with your co-wives? Have you regained your former status within the household?

- Have you resumed your social activities in the community? Can you go to the market? Can you take transportation? Can you go to the mosque? How do the people in your community treat you now? Are they aware of your surgery? Do they know you are cured? How did they learn about it? Did you tell them yourself?

- Do you still feel bitter toward members of your community/co-wives who mistreated you when you had fistula?

- How do you feel, personally? Do you still have dark thoughts/sad feelings (mental health screening)?

- Do you need help to reintegrate into your community, or has the surgery been sufficient?

- Do you think you have received adequate follow-up after surgery, and have you been able to access healthcare easily since then? What improvements do you think are necessary to help you after surgery?

- Do you have any questions?

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Désalliers, J., Paré, ME., Kouraogo, S. et al. Impact of surgery on quality of life of women with obstetrical fistula: a qualitative study in Burkina Faso. Int Urogynecol J 28, 1091–1100 (2017). https://doi.org/10.1007/s00192-016-3235-x

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