Evidence supports holistic approach to helping women recover from fistula
Fistula impacts up to 2 million women each year, mostly in sub-Saharan Africa. Access to surgery to repair the injuries has improved in the region, and many women experience improvements in physical and mental health following fistula repair alone. However, numerous women face continuing psychological and physical challenges to resuming their prior roles or adjusting to new circumstances.
The magnitude and urgency of the problem inspired International Journal of Gynecology and Obstetrics to devote a journal supplement to exploring the landscape for preventing and treating fistula. Bixby member Alison El Ayadi, Assistant Professor in the Departments of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, is leading essential research to understand how to best support women to return to normal lives after fistula repair surgery. She contributed a paper to the supplement to help fill the knowledge gap around the range of rehabilitation and reintegration services that are offered along with fistula repair surgery and identify areas where more research is needed.
Dr. El Ayadi and colleagues searched published and unpublished research since 2000, which covered programs including health education, physiotherapy, psychosocial counseling, social support and economic empowerment. The authors of that research generally supported holistic approaches to reintegration programming, calling for more resources to meet the many physical and mental health needs of women recovering from fistula. While many approaches including multiple elements, no one program modeled the holistic approach the authors recommended.
The challenges to implementing such ambitious programs including training, staffing and funding Delivering support programs at a healthcare facility was perceived as too limited to have meaningful long-term impacts; however, it is one of the most efficient ways to reach people. Other challenges included a mismatch between the short-term nature of economic empowerment programming and women’s needs, a pattern that’s seen in the wider research on alleviating poverty.
The available evidence suggests positive outcomes from several reintegration approaches. Physical therapy should be considered, both before and after the operation, including strengthening exercises and techniques to protect the pelvic floor. Including evidence-based psychosocial counseling is also critical. Future research should assess multicomponent interventions including health education, physical therapy, community and individual counseling and economic empowerment. Efficient strategies for long-term follow-up and integrating community and family linkage are needed.
Existing research supports a holistic approach to fistula care that addresses women’s mental, physical and economic needs through reintegration programming targeting short- and long-term outcomes. Dr. El Ayadi and colleagues strongly encourage researchers and service providers to implement more robust systems to evaluate the outcomes of their approaches and broadly share the results so the global community dedicating to improving lives of women with fistula can benefit.