Obstetric fistula in tanzania - EngenderHealth

channels that reach rural areas need to be prioritized, forexample radio broadcast and informational outreach throughfaith-based institutions such as churches and mosques.Beyond information, women must be supported actively toaccess fistula treatment. Given the severe economic impact offistula on women and their families, it is imperative thatfistula repairs be provided at minimal or no cost. Ideally,support should cover the costs of both transport andtreatment. Fistula programs have an ethical obligation todevelop mechanisms of such support, so that advocacy onfistula does not raise women’s expectations for treatmentwhen treatment is beyond reach.Finding 6: Even though most women withfistula had support from others, theemotional and economic impacts of fistulaare substantial for the woman herself, andfor her family.Although all of the women in the study mentioned beingsupported by at least one person when they sustained theirfistula, the majority of the women reported that they isolatedthemselves from their community. The women felt a strongsense of shame about their condition and did not want to soilthemselves in public or to smell badly. A majority of thewomen suffered stress and worry, including about the impactof the fistula on their families.Women and their families also suffered economically as aresult of the fistula. Nearly all of the women said that fistulaaffected their ability to work. Of these women, the majoritycould not work at all. As a result, their families were affectedby the loss of the woman’s contribution to work in the home,on the farm, or in earning income from other employment. Inaddition, families faced higher expenses in the dailymanagement of the woman’s condition, such as costs forextra clothes and soap, and in efforts to seek treatment torepair the fistula. Many families made great sacrifices to helpgirls and women get fistula repairs, including family membersforgoing work and income to accompany the women to seektreatment.Recommendation: Advocacy, support, and reintegrationefforts should be instituted to reduce the emotional andeconomic impacts of fistula.After successful repair, most women in the study resumedtheir normal lives, able to interact freely with their families,friends and communities, attend meetings and churchservices, and take active roles in economic activities. Manycalled their return to health “a miracle.” The findings alsoshow that families - including husbands - can, and do, supportwomen with fistula. These and other positive illustrations ofsupport from family, friends, and communities can be used inpublic education and advocacy efforts to break the stigmaaround fistula.Reintegration programs can strengthen opportunities forsuccessful re-entry after repair. However, to date, only limitedinformation is available on women’s experiences withreintegration. Further research is needed in this area sointerventions are based on a thorough understanding of whatwomen with fistula themselves need to help them begin lifeanew after repair. Reintegration efforts should also be mindfulof the potentially differing needs of women who have hadfistula for different periods of time, as it is possible thatstigma and isolation deepen the longer that a woman liveswith fistula.6