Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study

Female genital fistula is an injury that can happen during childbirth if women do not get high-quality care. It can be treated by surgery. After fistula surgery, women should not get pregnant right away so they can heal. To help women heal, we need to know how women with fistula think and feel about birth control. We collected data from 60 Ugandan women for one year after fistula surgery to learn about sex after surgery, contraceptive use, and pregnancy. We talked with 30 of them to learn more about their relationships, experiences with sex, plans for children, and birth control use. Most women were told to not have sex right away (97%) and many were told about birth control (59%). Some women had sex by 6-months after surgery (32%) and half by 12-months (50%). Most did not want to get pregnant (83%). Contraceptive use rose to 73% among those having sex by 12-months. Women who wanted to get pregnant soon were young, had fewer children, had lost their baby at fistula, and their partners wanted a child. Women told us they used contraception so they could recover from surgery or because they did not want a child right away. Some women told us they did not use contraception because they were worried it would hurt them. Others did not know enough about contraception. Patient education on contraception is needed at fistula surgery to help patients heal and meet their plans for children.