Social stigma and reintegration of obstetric Fistula survivors in west pokot, Kenya

Abstract

Obstetric fistula is a medical condition in which a woman develops a hole between the vagina and rectum or the bladder during delivery. In West Pokot, this condition attracts social stigma, abandonment, seclusion and isolation of the woman from family and general community. In this sense, obstetric fistula which is a medical condition has caused a social problem in the region. The condition is treated by corrective surgery. This exploratory study examined the problems faced by obstetric fistula survivors and challenges of re-integrating back into the community women who have undergone corrective surgery in West Pokot, Kenya. The main study objective was to explore the social stigma faced by obstetric fistula survivors and its effect on their reintegration into society. In-depth interviews, key informant interviews and focus group discussions were used to collect data. Eight women, aged between seventeen and thirty years, who had previously undergone obstetric fistula corrective surgery were interviewed. Questions about their experiences of living with obstetric fistula and the factors that influenced their reintegration after surgery were posed. Particularly, their experience of social stigma was explored. A focused group discussion consisting of obstetric fistula survivors, some who had earlier participated in the in-depth interviews was held to shed more light on the topic. Community members participated in a separate focus group discussion. Key informant interviews were held with two traditional birth attendants, surgeons, nurses and social workers in the district. The focus of the interviews was to provide information on how they manage/ support women with obstetric fistula, particularly the reintegration of fistula survivors into the community. The interviews andsdiscussions were taped then transcribed. In addition note taking was also employed to guard against technological failures. Thematic data analysis based on grounded theory techniques was used to analyze the data. The obstetric fistula survivors were mostly young women aged between seventeen and thirty years, with low literacy levels and were either divorced, separated or living with the,-\: husbands. Most of the survivors developed obstetric fistula delivering their first child. However a few had other children before the birth that caused the fistula. Survivors VI interviewed had lived with the condition for periods ranging between two to five years before surgery. The study established that social stigma which continues even after surgery is a major challenge that the women have to deal with daily, posing a great challenge to the reintegration of survivors. The stigma originates from the cultural beliefs and practices of the Pokot community. Fistula survivors who experienced social stigma after surgery were more likely to have problems coping with reintegration than those who didn't. There were other challenges of coping with after surgery instructions; divorce and separation; poverty and infertility that must be overcome before a survivor is sufficiently reintegrated. There is an apparent lack of a comprehensive reintegration program for obstetric fistula survivors that would address their needs after surgery in this region. The study recommends that after surgery, obstetric fistula survivors should be helped to reintegrate back to the community and proposes several avenues through which this could be done. Of these, long term counselling, income generating activities and education and skill training were proposed. Family and community support were vital in the reintegration of obstetric fistula survivors. The community is a major participant in eliminating social stigma; given that stigma is a social construct. Furthermore, many of the proposed reintegration strategies largely depend on the community for their success. The study therefore recommends that reintegration programs must be participatory, with an integrated approach amongst the various government sectors and NGO's in the region. -. Vll