Prevalence and correlates of adverse pregnancy outcomes following female genital fistula repair in Uganda: a mixed-methods study

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ABSTRACT Female genital fistula is a debilitating injury that affects 2 to 3 million women, mostly in sub-Saharan Africa. Women with fistula have uncontrollable leakage of urine and/or feces (among other physical symptoms), are heavily stigmatized, and experience high psychiatric morbidity. Preliminary evidence has identified risk of adverse pregnancy outcomes following fistula repair. However, the evidence base is not well developed, and robust estimation of stillbirth and other adverse pregnancy outcomes as well as characterization of factors contributing to post-repair pregnancy outcome is necessary for informing successful interventions to improve women's health following fistula repair. In an effort to improve the physical and psychosocial quality of life for women affected by fistula, we propose to address the critical gaps in knowledge on risk of adverse pregnancy outcomes following fistula repair through an explanatory sequential mixed-methods project among 200 women who have undergone fistula repair in the past 5 years at 4 fistula repair facilities in Uganda. We seek to quantitatively estimate the incidence of adverse pregnancy outcomes following fistula repair (Aim 1); and understand post-repair pregnancy decision-making and health care experiences of women previously repaired for genital fistula through in-depth interview with key stakeholders (women and providers); Aim 2). The research proposed herein will develop a robust estimate of stillbirth following fistula repair, and represents a first step toward establishing our understanding of factors contributing to adverse pregnancy outcomes in Uganda. It will directly support the development of a subsequent research proposal (R01) which will allow us to estimate risk factors of adverse post-repair outcomes and translate our findings into counseling and clinical care models for optimizing women's health and wellbeing in this population. Overall, our research program is expected to result in higher physical and psychosocial quality of life in both the short and long term for the increasing number of women undergoing surgical repair of female genital fistula, in Uganda and elsewhere.