Meet Dr. Alison El Ayadi, researcher taking on female genital fistula

Pregnancy and birth can be uniquely vulnerable times in a woman’s life. “It’s a time when a woman is in need of health care and support from others around her, even if she is otherwise very healthy,” says Dr. Alison El Ayadi, Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences. Seeing the importance of this time led Dr. El Ayadi to her groundbreaking work on exploring the continuum of care for obstetric complications, focused specifically on helping women return to normal lives after fistula repair.

Female genital fistula is a serious but preventable condition in which women develop a hole between the bladder or urethra and the vagina. It usually occurs during obstructed labor and leads to incontinence and other physical and mental problems. In Uganda, where Dr. El Ayadi works, fistula is far too common. Enormous strides have been made—there are now 11 facilities in Uganda where women can have fistula surgically repaired. But no one seemed to be addressing a crucial question: what happens to these women after surgery? “The prevalent model for fistula repair assumed that after undergoing surgery, women then return to their communities and everything goes back to normal immediately,” says Dr. El Ayadi. “It was difficult to believe that was the case given what women experience during fistula, and surgery does not resolve continence for all women with fistula.”

For the last five years, Dr. El Ayadi has been working with collaborators at Makerere University and Mulago Hospital in Kampala, Uganda, to learn what happens for women in Uganda after their fistula repair surgery. She wanted to better understand how women recover from the stigma that often accompanies fistula, in addition to the physical recovery. In the first research to look at a longer-term trajectory, she found that women’s physical and mental health improves dramatically after fistula repair. However, it also suggests that returning to happy and fulfilling lives may involve more than just surgery.

Her next step will be testing a facility-based program to support women in the long term after surgery. Participants will receive health education, psychological counseling, and physical rehabilitation. There will also be a focus on economic empowerment, connecting women with resources in their local communities.

While Dr. El Ayadi and others continue to fight for the ultimate goal of preventing fistula, her work will help meet the pressing needs of women who continue to have life-changing fistulas. Her vision is grounded in recognizing that access to this care is a human right. “It’s important to frame this with a human rights lens. There is a chain of failures that leads to women suffering with fistula. It has significant impacts on their lives, and they deserve our support.”