Risk and Resilience: Obstetric Fistula in Tanzania - EngenderHealth

findings are in sharp contrast to
research from other countries such
as Ethiopia, and the generally held
view that women living with
fistula are typically abandoned
and isolated by others.
Nevertheless, the majority of the
women reported that they
isolated themselves from their
community—a critically important
finding. This isolation was caused
by a strong sense of shame about
their condition and by the desire
not to soil themselves in front of
anyone or to smell badly. A
majority of the women suffered
stress and worry, including about
the impact of the fistula on their
families.
Both women and their families
suffered economically as a result
of the fistula. Nearly all of the
women said that fistula affected
their ability to work. Of these
women, the majority could not work at all. Fewer
than half could work, but they could not work as
hard as they did before the fistula. A few of the
woman reported that physically they could not
work, but that they had to in order to meet their
basic needs.
Families were affected by the fistula because as a
result one less person was working either in the
home or on the farm or was bringing in income
from other sources. As a result, remaining family
members had to do the work that the woman was
previously doing or forgo the income that the
woman previously contributed. Some families were
also in debt from the fees for delivery at the
hospital and from borrowing money for transport
to the hospital when the woman was in labor.
Many families made great sacrifices to help girls
and women get fistula repairs.
Recommendation 6: Advocacy, support, and
reintegration efforts should be instituted to reduce
the emotional and economic impacts of fistula.
Women interviewed after a successful repair talked
about having better relationships with their
community and no longer feeling isolated. They
were able to support themselves and their families
financially. Many called their return to health “a
miracle.”
The findings of the study suggest that positive
illustrations of support from family, friends, and
communities can be used in public education and
advocacy efforts to break the stigma around
fistula. The illustrations can also show that families
- including husbands - can, and do, support women
with fistula.
Reintegration programs can strengthen
opportunities for successful reentry after repair.
However, to date, information on women’s
experiences with reintegration is extremely limited.
Further research is needed in this area, so that
interventions can be based on a thorough
understanding of what women with fistula say that
they need to help them begin life anew after
repair. Reintegration efforts should also be mindful
of the potentially differing needs of women who
have had fistula for a long time and those living
with fistula for shorter periods, as it is possible that
stigma and isolation deepen with time.
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