An integrative review on women living with obstetric fistula and after treatment experiences

Aims and objectivesTo review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research. BackgroundObstetric fistula is an injury most commonly resulting from a prolonged labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women's experience is required to inform holistic approaches for care and prevention. DesignA search of literature was conducted on databases of EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; and websites of international organizations such as Women's Dignity Project and EngenderHealth. Keywords, Inclusion and exclusion criteria were defined and 25 articles published between 2004 to January 2015 were identified. MethodsAn integrative review of 25 articles was carried out. ResultsThree broad themes were identified: Challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fistula repair. ConclusionsLiving with a fistula presents multidimensional consequences affecting women, families and communities. Accessing treatment is difficult and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being continent thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Post repair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore further research is required to support its benefits; and for policy development to meet care provision for women with fistula. Relevance to clinical practiceThe review provides insights into avenues of improving care provision and delivery by health professionals and policy makers. It also exposes areas that need further research for quality care provision.