Introduction: Due to high fertility rates, low access to emergency obstetric care, and the poor quality of that care, obstetric fistula is relatively widespread in Niger.
Methods: Mixed-methods research was carried out over a total of eighteen months with 100 women with fistula at four fistula centers in Niger, three in the capital of Niamey and outside the city of Maradi.
Results: The one hundred women who made up the research sample reflect marked diversity in ethnicity, age, marital situation, parity, length of time living with fistula, and surgical history and outcomes. At the time of initial interviews women ranged from 15-70 years old (average 31.0±10.6), but had developed fistula from 13-54 years old (average 23.4 ±8.4). Women had lived with fistula between 1 month to 50 years (average 6.7 years ±8.6). At initial interview, women waited an average of 5.8 months (±9.9) while living at fistula centers, ranging from 2 weeks to 6 years. At the end of the research period, only 22 of the 61 women who underwent surgeries during the research period (36%) attained continence. The remaining 39 women (64%) were still incontinent.
Conclusions: Women with fistula in Niger’s clinics are more demographically diverse than commonly portrayed. Additionally, it was more difficult for women to access surgical repair and that repair was less successful than women themselves anticipated. Notably, the quality of care varied considerably between the four fistula centers. Long waits combined with poor surgical outcomes often resulted in negative social outcomes for women.
Niger, obstetric fistula, West Africa, stigma
Funding: This study was funded by the Wenner-Gren Foundation for Anthropological Research under Grant 8567; the Fulbright Hays under Grant P022A120012-002; the National Science Foundation under Grant 1243775; and the Worldwide Fistula Fund. Conflicts of Interest: In 2012 the author received a small research grant from the Worldwide Fistula Fund, the 501c3 that runs the Danja Fistula Center.
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Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics
Heller A. Demographic profile and treatment outcomes of 100 women with obstetric fistula in Niger. POG in Press. 2017 March; Article 2 [15 p.]. Available from: http://ir.uiowa.edu/pog_in_press/. Free full text article