New efforts needed to protect women's health after fistula repair

Female genital fistula is a devastating complication of giving birth that most often affects women in developing countries. It is a hole that develops between a woman’s birth canal and another organ, and usually occurs after a long, obstructed labor. Over the past decade, there has been significant international effort to achieve a “fistula-free generation,” and more than 100,000 fistula repair surgeries have been performed in sub-Saharan Africa and south Asia. Now more attention is needed on the period after repair to protect women’s health.

A group of researchers that included the Bixby Center’s Alison El Ayadi completed the first large study of women’s health following successful repair surgery in Guinea, and the findings raise concerns. The study found that 18% of women had another fistula within several years of the repair, and 10% had a return of urinary problems. Women attributed the recurrence to farm work, walking, sexual intercourse and later pregnancies and births.

Over a quarter of the women had a subsequent pregnancy during the study. In addition to another fistula, these women were more likely to have other negative birth outcomes, including stillbirth and maternal death. Of 50 women who delivered babies, only 9 did so via caesarean section. A c-section is recommended for all women after a fistula repair, and it is free of charge in Guinea.

After successful fistula repair, many women want to return to their communities and resume social roles, including having more children. This study highlights the need to offer continuing support beyond repair surgery, such as help accessing c-section care for later pregnancies or ongoing physical therapy. To achieve a fistula-free generation, we need to learn how best to follow up with women after repair surgeries to prevent recurrence and safeguard their health.